心血管整体评分在胎儿心律失常中的价值

The value of cardiovascular overall scores in fetal arrhythmia

目的 :产前超声检查研究胎儿心律失常的类型及发生率,并探讨心血管整体评分(Cardiovascular profile scores,CVPS)在胎儿心律失常中的价值。方法:回顾性分析2008年1月—2018年1月在四川大学华西第二医院超声科因胎儿心律失常而行针对胎儿心脏超声检查的孕妇共295例。按CVPS分值进行分层,总结心律失常类型、是否合并心内畸形及类型、是否合并心外异常及预后等。结果:295例孕妇平均年龄27.4±5.6岁,平均胎龄30.6±4.9周,其中CVPS小于4分的胎儿0例,而CVPS分值为4～10分胎儿分别有1例、9例、15例、21例、34例、48例、167例。其中房性心律失常共190例(64.4%),室性心律失常共28例(9.5%),室上性心动过速28例(9.5%),房室传导阻滞39例(13.2%),窦性心动过缓共15例(5.1%)。共有51(17.3%)例合并有心内结构畸形,共有14例(4.7%)合并有心外畸形。不良妊娠结局组共54例(18.3%),活产组共210例(71.2%),其中失访31例(10.5%),ROC曲线分析,曲线下面积(AUC)为0.754,活产组与不良妊娠结局组的Cut-off值为8.5(P<0.05),灵敏度为82.4%,特异度为59.3%。结论:在心律失常胎儿中,房性心律失常占绝大部分,与室性心律失常相似,二者CVPS分值均较高,预后较好;在CVPS分值明显降低的心律失常胎儿中,复杂心内、外畸形及不良妊娠结局的发生率较高,所以胎儿CVPS对胎儿心律失常妊娠结局的预测有重要的指导意义。

Objective:To study the type and incidence of fetal arrhythmia by prenatal ultrasound and to explore the value of Cardiovascular profile scores (CVPS)in fetal arrhythmias.Method:295 cases which were diagnosed with fetal arrhythmia and got further examination in Department of Ultrasound of West China Second Hospital of Siehuan University from January 2008 to January 2018 were recruited.Stratified according to CVPS scores,we summarized the type of fetal arrhythmia,the type of intra-cardiac and extra-cardiac malformation and analyzed the prognosis of these fetuses.Results:The average age of 295pregnant women was 27.4±5.6 years,and the average gestational age was 30.6±4.9weeks.Among them,there were 0 fetuses with a CVPS score less than 4,and there were 1,9,15,21,34,48and 167fetuses with a CVPS score between 4 and 10,respectively.Among them,there were 190 cases(64.4%)of atrial arrhythmia,28cases(9.5%)of ventricular arrhythmia, 28cases(9.5%)of supraventricular taehycardia,39 cases(13.2%)with atrioventrieular conduction block and 15cases(5.1%)with sinus bradycardia.51(17.3%)fetuses had intra-eardiac malformations,14(4.7%)had extra-cardiac malformations.54 cases (18.3%)were in the adverse pregnancy outcome group and 210cases (71.2%)were in the live birth group,but 31cases (10.5%)were lost to follow up.ROC curve analysis showed that the area under the curve (AUC)was 0.754,and the cut-off value of 8.5(P<0.05)in the live birth group and the adverse pregnancy outcome group,with a sensitivity of 82.4% and a specificity of 59.3%.Conclusion:In fetal arrhythmias,atrial arrhythmia accounts for the majority,which is similar to ventricular arrhythmia,CVPS scores of both are higher,and the prognosis of both can be better.For the fetus who has a significantly lower CVPS score,the incidence of complicated intra-eardiae and extra-cardiac malformations and adverse pregnancy outcome is relatively higher.Therefore,the fetal CVPS has important guiding significance for the prediction of fetal arrhythmia pregnancy outcome.