胎儿超声心动图显像在先天性心脏畸形筛查中的应用

Application of fetal echocardiographic imaging in screening congenital cardiac malformation

目的探讨胎儿超声心动图联合传统彩色多普勒血流显像(CDFI)在筛查先天性心脏畸形中的应用。方法选择2013年4月至2018年4月于陕西省榆林市榆阳区妇幼保健院接受产前检查的100例妊娠大于18周且具有高危倾向的孕产妇为研究对象,分别对其实施胎儿超声心动图及CDFI检测,评估两种检测方式在先天性心脏畸形中的筛查效果。结果经上级医院复查或产后检测发现,100例孕产妇中有32例胎儿存在先天性心脏畸形,以此为金标准,超声心动图对先天性心脏畸形检测的一致性为84.00%,灵敏度为62.50%,特异度为94.12%,阳性预测值为83.33%,阴性预测值为84.21%;CDFI对先天性心脏畸形检测的一致性为88.00%,灵敏度为71.88%,特异度为95.59%,阳性预测值为88.46%,阴性预测值为86.67%;超声心动图联合CDFI对先天性心脏畸形检测的一致性为97.00%,灵敏度为93.75%,特异度为98.53%,阳性预测值为96.77%,阴性预测值为97.10%;超声心动图及CDFI对先天性心脏畸形筛查的一致性、灵敏度、特异度差异无统计学意义(P>0.05),而超声心动图与CDFI联合检测的一致性、灵敏度、特异度明显优于超声心动图及CDFI单独检测(P<0.05)。结论超声心动图联合CDFI在筛查先天性心脏畸形中具有较好的应用效果,能够为围生期正确处理提供重要的指导作用。

Objective To explore the application of fetal echocardiography combined with traditional color Doppler flow imaging(CDFI)in screening congenital heart malformation.Methods One hundred pregnant and lying-in women with gestation>18 weeks and high risk trend receiving the prenatal examination in the Yuyang District Maternal and Child Health Care Hospital from April 2013 to April 2018 were selected as the study subjects.The fetal echocardiography and CDFI examinations were performed to evaluate their effects in screening congenital heart malformation.Results The recheck by superior hospital or postpartum examination revealed that among 100 pregnant and lying-in women,the congenital heart malformations existed in 32 cases of fetus.With this as the gold standard,the consistency of echocardiography for detecting congenital heart malformation was 84.00%,the sensitivity was 62.50%,the specificity was 94.12%,the positive predictive value was 83.33%and the negative predictive value was 84.21%;the consistency of CDFI for detecting congenital heart malformation was 88.00%,the sensitivity was 71.88%,the specificity was 95.59%,the positive predictive value was 88.46%,and the negative predictive value was 86.67%;the consistency of echocardiography combined with CDFI for detecting congenital cardiac malformation was 97.00%,the sensitivity was 93.75%,the specificity was 98.53%,the positive predictive value was 96.77%,and the negative predictive value was97.10%;the consistency,sensitivity and specificity of echocardiography and CDFI for screening congenital heart malformation had no statistically significant difference(P>0.05),while the consistency,sensitivity and specificity of echocardiography combined with CDFI were significantly superior to those of single detection of echocardiography and CDFI(P<0.05).Conclusion Echocardiography combined with CDFI has a good application effect in screening congenital heart malformation,which can provide an important guidance role for the correct treatment during perinatal period.