胎儿超声心动图标准切面在胎儿单纯室间隔缺损孕期诊断中的作用
The role of fetal echocardiography standard section in the diagnosis of fetal simple ventricular septal defect during pregnancy
庞海苏 1朱晓丹 1戚夏近 1周林玉1
作者信息
- 1. 浙江大学医学院附属第一医院,浙江杭州 310003
- 折叠
摘要
目的 探讨胎儿超声心动图标准切面在胎儿单纯室间隔缺损(i-VSD)孕期诊断中的作用.方法 选择2021年11月至2023年3月于浙江大学医学院附属第一医院进行孕期检查的孕妇122例,根据产前检查任何时间的超声心动图诊断和产后随访一年内诊断结果分为i-VSD组(n=50)和正常对照组(n=72),比较两组患者的一般资料、血流动力学参数及超声标准切面相关参数.采用受试者操作特征(ROC)曲线评估胎儿超声心动图标准切面参数联合对孕期胎儿i-VSD中的诊断价值.Logistic回归分析胎儿超声心动图标准切面参数与胎儿i-VSD的关系.采用非条件Logistic回归模型分析主动脉肺动脉峰值流速之比(AO/PA)和室间隔缺损大小(VSD)对孕期胎儿i-VSD的相乘交互作用.多因素Logistic分析孕期胎儿发生i-VSD的独立危险因素.建立结构方程预测模型并进行验证.结果 i-VSD组糖尿病、合并结缔病、不良妊娠史、家族病史、孕期接触致畸物质患者比例以及胎儿早期NT值相较于正常对照组患者更高;与正常对照组患者相比,i-VSD组患者脐动脉搏动指数(UA-PI)、脐动脉阻力指数(UA-RI)水平更高,而大脑中动脉搏动指数(MCA-PI)、脑/脐血管搏动指数比值(MCA/UA-PI)、脑/脐血管阻力指数比值(MCA/UA-RI)水平更低(P＜0.05);i-VSD组与正常对照组患者AO/PA及V SD等指标间的差异具有统计学意义(P＜0.05);胎儿超声心动图标准切面参数对孕期胎儿i-VSD的诊断效能良好.其中AO/PA及VSD两个参数联合诊断i-VSD,诊断效能更高;校正混杂因素后,AO/PA及VSD与孕期胎儿i-VSD呈负相关;交互作用分析结果显示,AO/PA和V SD存在相乘及相加交互作用;多因素Logistic回归分析显示糖尿病、合并结缔病、不良妊娠史、家族病史、孕期接触致畸物质、胎儿早期 NT 值、UA-PI、UA-RI 升高,MCA-PI、MCA/UA-PI、MCA/UA-RI、AO/PA、V SD 降低均为孕期胎儿 i-VSD 的危险因素(P＜0.05);结构方程模型整体适配情况较优,能很好地反映各影响因素与孕期胎儿i-VSD发生的关系.预测模型区分度、独立性较好.结论 胎儿超声心动图标准切面能够有效诊断孕期胎儿i-VSD的发生,且胎儿超声心动图标准切面相关参数中AO/PA、VSD联合对i-VSD具有良好的诊断效能.
Abstract
Objective To discuss the role of fetal echocardiography standard section in the diagnosis of fetal simple ventricular septal defect(i-VSD)during pregnancy.Methods A total of 122 pregnant women who underwent prenatal exami-nation in the First Affiliated Hospital of Zhejiang University School of Medicine from November 2021 to March 2023 were selected and divided into i-VSD group(n=50)and normal control group(n=72)according to echocardiography diagnosis at any time during prenatal examination and one year postpartum follow-up.The general data,hemodynamic parameters and parameters of ultrasound standard section were compared between the two groups.Receiver operating characteristic(ROC)were used to evaluate the diagnostic value of fetal echocardiography standard section parameters combined with i-VSD in pregnant fetuses.Logistic regression was used to analyze the relationship between fetal echocardiogram standard section pa-rameters and fetal i-VSD.An unconditional Logistic regression model was used to analyze the multiplicative interactions of the ratio of aortopulmonary peak velocity(AO/PA)and ventricular septal defect size(V SD)on fetal i-VSD during pregnancy.Multivariate Logistic analysis of the independent risk factors of fetal i-VSD during pregnancy.The structural equation predic-tion model was established and verified.Results The proportion of patients with diabetes mellitus,associated disease,adverse pregnancy history,family history,prenatal exposure to teratogenic substances and early fetal NT value in i-VSD group were higher than those in normal control group.The levels of umbilical artery pulse index(UA-PI)and umbilical artery resistance index(UA-RI)in i-VSD group were higher than those in normal control group.The middle cerebral artery pulse index(MCA-PI),brain/cord blood tube pulse index ratio(MCA/UA-PI),brain/cord blood tube resistance index ratio(MCA/UA-RI)were lower(P＜0.05).There were significant differences in AO/PA and V SD between i-VSD group and normal control group(P＜0.05).The standard section parameters of fetal echocardiography were effective in the diagnosis of i-VSD in pregnant fetus.The combined diagnosis of i-VSD with AO/PA and V SD had higher diagnostic efficiency.After adjusting for confounders,AO/PA and V SD were negatively correlated with fetal i-VSD during pregnancy.The results of interaction analysis showed that there were multiplicative and additive interactions between AO/PA and V SD.Multivariate Logistic regression analysis showed that diabetes mellitus,associated association disease,adverse pregnancy history,family history,prenatal exposure to teratogenic substances,early fetal NT value,UA-PI,UA-RI increased.Decreased MCA-PI,MCA/UA-PI,MCA/UA-RI,AO/PA and V SD were all risk factors for i-VSD during pregnancy(P＜0.05).The overall fit of structural equation model was better,which could reflect the relationship between the influencing factors and the occurrence of i-VSD in the fetus.The pre-diction model had good differentiation and independence.Conclusion The standard section of fetal echocardiography could effectively diagnose the occurrence of i-VSD in pregnant fetuses,and the combination of AO/PA and V SD among the relevant parameters of the standard section of fetal echocardiography had good diagnostic efficacy for i-VSD.
关键词
胎儿/超声心动图/标准切面/单纯室间隔缺损/孕期Key words
fetus/echocardiography/standard section/simple ventricular septal defect/gestation引用本文复制引用
出版年
2024
NETL
NSTL
万方数据