产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析

Clinical significance of prenatal ultrasound screening for fetal congenital heart disease and analysis of the high risk factors

目的研究产前超声筛查胎儿先天性心脏病的临床意义及高危因素。方法选取我院2013年1月～2016年1月收治的2035例孕妇为研究对象，对其进行超声筛查，并对其临床资料进行回顾性分析，采用单因素及Logistic回归多因素分析先天性心脏病相关因素。结果产前超声筛查诊断为先天性心脏病20例，误诊2例，漏诊3例，应用产前超声筛查对先天性心脏病诊断敏感度、特异度、阳性预测值、阴性预测值、诊断准确率分别为85．7％（18／21）、99．9％（2012／2014）、90．0％（18／20）、99．9％（2012／2015）、99．8％（2030／2035）。经过单因素及多因素Logistic回归分析显示：流产史≥2次、妊娠期合并症、孕期被动吸烟、孕期使用抗生素、父母职业接触有害物质、纤维蛋白原〈3g／L、24h尿蛋白≥3g／24h是先天性心脏病的危险因素（P〈0．05）。结论超声筛查在诊断先天性心脏病方面具有一定临床价值，对于存在多次流产、妊娠期合并症、24h尿蛋白偏高、纤维蛋白原偏低、胎位异常、胎膜早破等高危孕妇应该高度警惕，加强监护，做到早诊断早干预，以改善妊娠结局。

Objective To study the clinical significance and risk factors of prenatal ultrasound screening for fetal con- genital heart disease. Methods A total of 2035 cases of pregnant women in our hospital from January 2013 to January 2016 were selected as the research objects, which were examined by the ultrasound screening. The clinical data were retrospectively analyzed and factors associated with congenital heart disease were also analyzed by using a single factor and Logistic multivariate regression analysis. Results 20 cases were diagnosed as congenital heart disease by prenatal ultrasound screening, 2 cases were misdiagnosed and 3 cases with missed diagnosis. By using prenatal ultrasound screening in the diagnosis of congenital heart disease, the sensitivity, specificity, positive prediction value and negative prediction value and the accuracy rate of diagnosis were respectively 85.7%（18/21）, 99.9%（2012/2014）, 90.0%（18/20）, 99.9%（2012/2015） and 99.8%（2030/2035）. The single factor and multi factor Logistic regression analysis showed that the risk factors of congenital heart disease were the history of abortion ≥2 times, pregnancy complications, passive smoking during pregnancy, pregnancy using antibiotics, parents occupation exposure to harmful substances, fibrin orig- inal〈3 g/L and the urine protein ≥ 3 g/2g h （P〈0.05）. Conclusion Ultrasound screening in the diagnosis of congenital heart disease has certain clinical value for the existence of multiple miscarriages, pregnancy complications, and the urine protein in 24 hours, low fibrinogen, abnormal fetal position and premature rupture of fetal membranes. The high risk pregnant women should be highly vigilant and the monitoring should be strengthened, so early diagnosis and early intervention should be carried out in order to improve the outcome of pregnancy.