McGoon指数及Z-评分在胎儿右心室流出道梗阻性疾病中的定量研究

Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction

目的探讨Z-评分及McGoon指数(MGI)在评估胎儿右心室流出道梗阻(RVOTO)中的应用价值。方法选取自2020年6月至2022年1月在浙江大学医学院附属邵逸夫医院超声科经胎儿超声心动图诊断为RVOTO的胎儿67例,根据梗阻程度将观察组分为4组[轻度肺动脉狭窄(PS)组17例、中重度PS组16例、法洛四联症(TOF)组19例、肺动脉闭锁组15例],选取同期检查的正常胎儿70例作为对照组,比较5组的主动脉内径Z-评分(AO Z-评分)、肺动脉内径Z-评分(PA Z-评分)、左肺动脉内径Z-评分(LPA Z-评分)、右肺动脉内径Z-评分(RPA Z-评分)及MGI的差异。结果随着RVOTO程度加重,MGI呈下降趋势;PA及LPA、RPA的Z-评分整体呈下降趋势;AO Z-评分整体呈上升趋势,差异均有统计学意义(均P<0.05)。对照组与轻度PS组比较,PA Z-评分、RPA Z-评分及AO Z-评分差异有统计学意义(均P<0.05)。对照组与中重度PS组、TOF组、肺动脉闭锁组比较,MGI及各血管Z-评分差异均有统计学意义(均P<0.05)。轻度PS组与中重度PS组比较,PA、LPA的Z-评分差异均有统计学意义(均P<0.05)。轻度PS组与TOF组比较,MGI、肺动脉及其分支Z-评分差异均有统计学意义(均P<0.05);轻度PS组与肺动脉闭锁组比较,MGI、PA及LPA的Z-评分差异均有统计学意义(均P<0.05);中重度PS组与TOF组比较AO Z-评分差异有统计学意义(P<0.05);中重度PS组与肺动脉闭锁组比较,RPA Z-评分、AO Z-评分差异有统计学意义(均P<0.05);TOF组与肺动脉闭锁组比较,RPA Z-评分差异有统计学意义(P<0.05)。结论MGI及Z-评分可定量分析比较正常组及不同程度RVOTO胎儿肺动脉及其分支的发育情况。PS程度相近的胎儿肺动脉发育情况评估,Z-评分优于MGI。

Objective To evaluate the value of Z-score and McGoon index(MGI)in the diagnosis of fetal right ventricular outflow tract obstruction(RVOTO).Methods Sixty-seven fetuses with RVOTO diagnosed by fetal echocardiography at Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from June 2020 to January 2022 were included.According to the degree of obstruction,the fetuses was divided into 4 groups:mild pulmonary stenosis(PS)group(n=17),moderate and severe PS group(n=16),tetralogy of Fallot(TOF)group(n=19),and pulmonary atresia group(n=15).Seventy normal fetuses who underwent examination during the same period were selected as controls.The differences in aortic(AO)diameter Z-score,pulmonary artery(PA)diameter Z-score,left pulmonary artery(LPA)diameter Z-score,right pulmonary artery(RPA)diameter Z-score,and MGI were compared among the five groups.Results With the aggravation of RVOTO,MGI showed a downward trend,the PA,LPA,and RPA Z-scores also showed a downward trend,and the AO Z-score showed a upward trend;the differences were statistically significant(P<0.05).There were significant differences in the PA,RPA,and AO Z-scores between the control group and mild PS group(P<0.05).There were significant differences in MGI and Z-scores among the control group,moderate and severe PS group,and TOF group,and pulmonary atresia group(P<0.05).There were significant differences in PA and LPA Z-scores between the mild PS group and moderate and severe PS group(P<0.05 for both),in MGI and Z-scores of the pulmonary artery and its branches between the mild PS group and TOF group(P<0.05 for both),in MGI and PA and LPA Z-scores between the mild PS group and pulmonary atresia group(P<0.05 for all),in AO Z-score between the moderate and severe PS group and TOF group(P<0.05),in RPA and AO Z-scores between the moderate and severe PS and pulmonary atresia group(P<0.05 for both),and in RPA Z-score between the TOF group and pulmonary atresia group(P<0.05).Conclusion MGI and Z-score can be used to quantitatively assess and compare the development of the pulmonary artery and its branches between normal fetuses and RVOTO fetuses,and provide reference information for accurate quantitative analysis of fetal pulmonary artery development among RVOTO of different severities.In the comparison between groups with similar degree of RVOT,Z-score is superior to MGI.