左心室短轴缩短率、射血分数评估α地中海贫血胎儿心功能的研究

Evaluation of heart function in fetus withα-thalassemia by left ventricular fraction shortening and ejection fraction

目的探讨M型超声心动图检测胎儿左心室收缩功能指标心室短轴缩短率(FS)、射血分数(EF),评估α地中海贫血(α地贫)胎儿心功能状况的价值。方法对78例孕龄16～40周胎儿有α地贫风险的单胎妊娠妇女行系统超声及M型超声心动图检查,分别测量胎儿左心室的FS、EF。地贫组胎儿36例,对照组42例。地贫组包括重型α地贫18例、中间型α地贫4例、轻型α地贫14例。随访妊娠结局。结果所有胎儿左心室的FS、EF不随着孕龄的增加而递增。重型α地贫组胎儿FS低于对照组胎儿,差异有统计学意义(P<0.01);其他组胎儿的FS、EF两两比较,差异无统计学意义(P>0.05)。结合二维超声声像图,左心室FS<0.28、EF<60%判断胎儿重型α地贫的敏感度为28%、特异度为86%。结论左心室FS和EF可作为评估α地中海贫血胎儿心功能状况的一项重要指标。

Objective To investigate the value of fraction shortening （ FS ） and ejection fraction （EF） of the left ventricle in evaluating the heart function of fetus with α - thalassemia by M - mode echocardiogram. Methods Seventy - eight singleton pregnancies at risk due to fetal thalassemia who were at 16 -40 weeks gestation were enrolled in this study. They were examined by two - dimensional ultrasound imaging and M - mode echocardiogram. The FS and the EF of left ventricle in fetus were measured. There were 36 thalassemic fetuses and 42 normal fetuses. Among these thalassemic fetuses, 18 cases of serious α-thalassemia, 4 cases of α- thalassemia Intermedia, 14 cases of mild α- thalassemia. All the pregnancy outcome was followed up. Results EF and FS didn＇ t increase with the increasing gestational age in all fetuses. The FS in serious α - thalassemia was lower than that in normal control group, there was significant difference between two groups （ P 〈 0.01 ）. While there was no significant difference in FS and EF between the other groups （ P 〉 0.05 ）. Combined with two - dimensional ultrasonic imaging, FS 〈 0.28 and EF 〈 60% diagnosing the fetal serious α - thalassemic have specificity of 28% and specificity of 86%. Conclusion FS and EF of left ventricle can be an important index in evaluating heart function in fetus with α - thalassemia.