超声多普勒在孕中期单纯室间隔缺损胎儿中的诊断价值

Prognostic Value of Doppler Sonography for Ventricular Septal Defect in the 19-24 Weeks Gestation

【目的】探讨超声多普勒在孕19～24周单纯室间隔缺损（ventricular septal defect，VSD）胎儿中的诊断价值。【方法】采用单中心前瞻性研究方法，选择2012年12月至2015年1月本院行产前检查孕妇3752例，根据产前检查任何时间B超诊断和产后随访一年内诊断结果分为VSD组（217例）和正常对照组（3535例）。记录并比较两组孕19～24周时的胎儿血流动力学指标：脐动脉搏动指数（UA-PI）、脐动脉阻力指数（UA-RI）；大脑中动脉搏动指数（MCA-PI）、大脑中动脉阻力指数 （MCA-RI）；脾动脉搏动指数（SpA -PI）、脾动脉阻力指数（SpA -RI）、脾动脉收缩期血流峰值速度（SpA-PSV）；脑/脐血管搏动指数比值（MCA/UA-PI）和脑/脐血管阻力指数比值（MCA/UA-RI）。【结果】VSD组胎儿的UA-PI（1.31 ±0.54）、UA-RI（0.77±0.33）显著高于对照组（1.09 ±0.33和0.68 ±0.23）（P〈0.05），MCA-PI（1.48 ±0.24）、MCA/UA-PI（1.12±0.29）、MCA/UA-RI（0.99 ±0.18）显著低于对照组（1.61 ±0.33、1.38 ±0.33和1.11 ±0.20）（P〈0.05）;但两组MCA-RI、SpA-PI、SpA-RI、SpA-PSV比较差异无统计学意义（P＞0.05）。Logistic回归分析显示UA-PI升高（OR=6.314，95%CI： 2.400～24.803）、MCA-PI（OR=5.887，95%CI： 1.078～13.637）和MCA/UA-PI降低（OR=11.283，95%CI： 1.597～106.442）是预测VSD的独立危险因素。【结论】孕19～24周时 UA-PI升高、MCA-PI和MCA/UA-PI降低是预测胎儿VSD发生的有效指标。

【Objective】To investigate the prognostic value of Doppler sonography for the ventricular septal defect（VSD） in the 1924 weeks gestation. 【Methods】 A singlecentre prospective observational study was conducted.The pregnant women who underwent the prenatal examination in our hospital from December 2012 to January 2015 were enrolled and were divided into the VSD group（217 cases） and the control group （3535 cases） according to the prenatal ultrasound diagnosis examination at any time and followup within one year of diagnosis results. Fetal hemodynamics of the two groups of pregnant 19 to 24 weeks were recorded and compared ： umbilical artery pulsatility index （UAPI） ; middle cerebral artery pulsatility index （MCAPI）, middle cerebral artery resistance index（ MCARI）; splenic artery pulsatility index PI （SPAPI）, splenic artery resistance index （SPA RI）, splenic artery peak systolic velocity （SpAPSV）; brain / umbilical pulsatility index ratio （MCA/UAPI ）and brain / umbilical vascular resistance index ratio （MCA/UARI）. 【Results】 Fetal UAPI （1.31 ± 0.54）, UARI （0.77±0.33） of the VSD group were significantly higher than those the control group （1.09 ±0.33 and 0.68 ± 0.23） （P〈0.05）, MCAPI （1.48 ± 0.24）, MCA/UAPI （1.12 ± 0.29）, MCA/UARI （0.99 ±0.18） were significantly lower than those of the control group （1.61 ±0.33, 1.38 ± 0.33 and 1.11 ± 0.20） （P〈0.05）, but no statistically significant difference exist in MCARI, SpA, PI, SpA, RI, SpAPSV between the two groups （P〉0.05）. Logistic regression analysis showed that the increase of UAPI （OR=6.314, 95% CI： 240 ~ 24.803） and the decrease of MCAPI （OR=5.887, 95% CI： 1.078 to 13.637） and MCA/UAPI （OR=11.283, 95% CI： 1.597 ~ 106.442） were independent risk factors for prediction of VSD.【Conclusion】At 19 to 24 weeks, the increase of UAPI and the decrease MCAPI and MCA/UAPI are useful marker to predict the occurrence of fetal VSD.