胎儿心脏定量技术评估正常胎儿心脏形态与功能:一项前瞻性队列研究  

Fetal heart quantification technology for assessing normal fetal cardiac morphology and function:a prospective cohort study

作　　者：狄秋怡 龙湘党[1] 宁靖 姚穗[3] 李巧荣 卓宇 陈萱 史龙飞 Di Qiuyi;Long Xiangdang;Ning Jing;Yao Sui;Li Qiaorong;Zhuo Yu;Chen Xuan;Shi Longfei(Department of Ultrasonography,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410000,China;Department of Ultrasonography,Changsha Central Hospital(the Affiliated Hospital of the University of South China),Changsha 410007,China;Department of Obstetrics,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410000,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)超声科,长沙410000 [2]长沙市中心医院(南华大学附属医院)超声科,长沙410007 [3]湖南省人民医院(湖南师范大学附属第一医院)产科,长沙410000

出　　处：《中华围产医学杂志》2025年第3期211-218,共8页Chinese Journal of Perinatal Medicine

基　　金：湖南省教育厅科研项目-重点项目(21A0038);湖南省自然科学基金-科卫联合项目(2020JJ8013)。

摘　　要：目的探讨胎儿心脏定量(fetal heart quantification,Fetal HQ)技术评估正常胎儿心脏形态与功能的价值。方法本研究为前瞻性队列研究,纳入2023年1月至2024年10月在湖南省人民医院接受产前超声检查的胎儿正常的健康孕妇。应用GE Voluson E10彩色多普勒超声诊断仪行常规产科超声检查和胎儿超声心动图检查,评估胎儿生长发育情况,排除心内心外畸形;采集四腔心切面(four-chamber view,4CV)清晰显示心内膜的心脏动态图(时间≥3 s),应用Fetal HQ软件进行在机斑点跟踪分析,测量指标包括心脏整体球形指数(global spherical index,GSI)、心脏舒张末期长径(end-diastolic length of the heart,L-ED)与横径(end-diastolic width of the heart,W-ED)以及左心室(left ventricle,LV)、右心室(right ventricle,RV)的整体纵向应变(global longitudinal strain,GLS)、面积变化率(fractional area change,FAC)和24节段球形指数(spherical index,SI)。按产前超声检查孕周分为孕20^(+0)~23周^(+6)、24^(+0)~27周^(+6)、28^(+0)~31周^(+6)、32^(+0)~35周^(+6)和36^(+0)~40周^(+6)组。采用单因素方差分析、两独立样本t检验、单因素线性回归分析和Pearson相关性分析探讨上述指标在不同孕周组之间的差异及其与孕周的相关性。结果共200例孕妇纳入队列,剔除4例(因图像质量欠佳无法准确描迹获得相关指标),余196例(孕20^(+0)~23周^(+6)组40例、24^(+0)~27周^(+6)组34例、28^(+0)~31周^(+6)组41例、32^(+0)~35周^(+6)组48例、36^(+0)~40周^(+6)组33例)的图像纳入分析,图像分析成功率为98.0%(196/200)。(1)4CV L-ED、4CV W-ED、LV-FAC和RV-FAC在孕20^(+0)~23周^(+6)、24^(+0)~27周^(+6)、28^(+0)~31周^(+6)、32^(+0)~35周^(+6)、36^(+0)~40周^(+6)组间差异均有统计学意义[4CV L-ED:28.0±3.0、32.6±4.3、40.9±4.3、46.7±4.8、53.1±5.8,F=3.72;4CV W-ED:21.9±1.8、25.1±4.2、31.7±3.0、37.4±4.0、42.0±4.9,F=2.61;LV-FAC:(51.4±8.0)%、(49.0±10.4)%、(47.3±7.3)%、(43.1±7.5)%、(40.7±8.ObjectiveTo explore the value of fetal heart quantification technology in assessing the morphology and function of the fetal heart during normal pregnancy.MethodsThis prospective cohort study selected normal fetuses from healthy pregnant women who underwent prenatal ultrasound examinations at Hunan Provincial People's Hospital from January 2023 to October 2024.Using the GE Voluson E10 color Doppler diasonography,routine obstetric ultrasound and fetal echocardiography were performed to assess fetal growth and development and to exclude intracardiac and extracardiac malformations.Clear four-chamber view(4CV)dynamic images of the heart showing the endocardium(duration≥3 s)were collected.Speckle-tracking analysis was performed using fetal heart quantification software.The measured indicators included the global spherical index(GSI),end-diastolic length of the heart(L-ED),end-diastolic width of the heart(W-ED),and the global longitudinal strain(GLS),fractional area change(FAC),and 24-segment spherical index(SI)of the left ventricle(LV)and right ventricle(RV).The cases were divided into five groups based on gestational age at the time of prenatal ultrasound:20^(+0) to 23^(+6),24^(+0) to 27^(+6),28^(+0) to 31^(+6),32^(+0) to 35^(+6),and 36^(+0) to 40^(+6) weeks.One-way analysis of variance,two independent samples t-test,univariate linear regression analysis,and Pearson correlation analysis were used to explore the differences in the above indicators among different gestational age groups and their correlation with gestational age.ResultsA total of 200 pregnant women were included in the cohort,four cases were excluded due to poor image quality that prevented accurate tracking and measurement of relevant indicators.Ultimately,196 cases(20^(+0) to 23^(+6) weeks 40 cases,24^(+0) to 27^(+6) weeks 34 cases,28^(+0) to 31^(+6) weeks 41 cases,32^(+0) to 35^(+6) weeks 48 cases,and 36^(+0) to 40^(+6) weeks 33 cases)were included in the study,with a successful image analysis rate of 98.0%.(1)There were statistically significant

关 键 词：胎儿心脏定量 超声心动图 胎儿 心脏形态 心脏功能 

分 类 号：R714.5[医药卫生—妇产科学]