摘要
目的:探究超声"四切面"法联合妊娠中期孕妇血清游离人绒毛膜促性腺激素(Freeβ-hCG)和雌三醇(uE3)筛查胎儿严重先天性心脏病(CHD)的临床应用价值.方法:选择 2020 年 1 月到2021 年6 月我院行妊娠中期CHD筛查的孕妇97 例,检测孕妇血清 Freeβ-hCG 和 uE3 水平,采用超声"四切面"法筛查CHD,分析超声"四切面"法联合血清Freeβ-hCG和uE3 水平对CHD的诊断价值.结果:97 例孕妇随访确诊为严重CHD 9 例(9/97,9.28%);超声"四切面"法检查提示高危胎儿 25 例,其中4 例确诊为严重CHD(4/25,16.00%);孕妇血清学检测提示高危胎儿 36 例,其中 6 例最终确诊为严重CHD(6/36,16.67%);超声"四切面"法联合孕妇血清学检测提示高危胎儿 9 例,其中 5 例确诊为严重CHD(5/9,55.56%).超声"四切面"法筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为16.00%、93.51%、74.51%、44.44%和77.22%.孕妇血清Freeβ-hCG和uE3 水平筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.31%、92.08%、66.67%和64.00%,;二者联合筛查严重 CHD 的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为 55.56%、95.65%、92.08%、55.56%和91.09%.二者联合检测的诊断情况高于单一检测方法(P<0.05).结论:超声"四切面"法对妊娠中期孕妇筛查严重CHD具有较高的诊断价值,联合孕妇血清Freeβ-hCG和uE3 水平能进一步提高诊断准确度,具有较好的临床应用价值.
Abstract
Objective:To investigate the clinical application value of the"four-plane"method of ultra-sound combined with mid-pregnancy maternal serum free human chorionic gonadotropin(Freeβ-hCG)and estriol(uE3)for screening severe congenital heart disease(CHD)in fetuses.Methods:A total of 97 preg-nant women who underwent mid-pregnancy CHD screening in our hospital from January 2020 to June 2021 were selected.The maternal serum Freeβ-hCG and uE3 levels were detected,and the"four-plane"method of ultrasound was used to screen for CHD.The diagnostic value of the"four-plane"method of ultrasound combined with serum Freeβ-hCG and uE3 levels for CHD was analyzed.Results:A total of 9 cases(9/97,9.28%)of severe CHD were confirmed by follow-up;25 cases of high-risk fetuses were detected by the"four-plane"method of ultrasound,of which 4 cases were confirmed to have severe CHD(4/25,16.00%);36 cases of high-risk fetuses were detected by maternal serum biochemical test,of which 6 cases were finally confirmed to have severe CHD(6/36,16.67%);and 9 cases of high-risk fetuses were detected by the com-bined"four-plane"method of ultrasound and maternal serum biochemical test,of which 5 cases were con-firmed to have severe CHD(5/9,55.56%).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the"four-plane"method of ultrasound for screening severe CHD were 16.00%,93.51%,74.51%,44.44%,and 77.22%,respectively.The sensitivity,specificity,accuracy,posi-tive predictive value,and negative predictive value of maternal serum Freeβ-hCG and uE3 levels for screening severe CHD were 55.56%,95.31%,92.08%,66.67%,and 64.00%,respectively.The sensitivity,speci-ficity,accuracy,positive predictive value,and negative predictive value of the combined screening for severe CHD were 55.56%,95.65%,92.08%,55.56%,and 91.09%,respectively.The diagnostic results of the combined detection were higher than those of the single detection method(P<0.05).Conclusion:The"four-plane"method of ultrasound has a high diagnostic value for screening severe CHD in pregnant women in mid-pregnancy.The combination of maternal serum Freeβ-hCG and uE3 levels can further improve the diagnostic accuracy and has good clinical application value.
基金项目
河北省卫生健康委医学科学研究课题(20231369)
承德市科技计划(202204A052)
万方数据