二维与四维超声用于产前胎儿心脏筛查的价值比较

VALUE OF TWO-DIMENSIONAL VERSUS FOUR-DIMENSIONAL ECHOCARDIOGRAPHY IN PRENATAL FETAL HEART SCREENING:A COMPARATIVE ANALYSIS

目的比较二维与四维超声在产前胎儿心脏筛查中的应用价值。方法回顾性分析2014年8月—2016年10月在我院接受产前胎儿心脏筛查的孕妇的临床资料,所有孕妇均接受二维和四维超声检查。统计胎儿心脏畸形检出率,分析比较二维和四维超声对胎儿心脏畸形诊断的准确率、特异度和灵敏度。结果 4 500例接受产前筛查的高危孕妇中,确诊存在胎儿心脏畸形者66例,其中法洛四联症10例,永存动脉干7例,右心室双出口5例,下腔静脉离断3例,房室间隔缺损6例,大动脉转位2例,永存左上腔静脉12例,肺动脉瓣狭窄4例,室间隔缺损13例,单心室3例,三尖瓣下移畸形1例,胎儿心脏畸形检出率为1.47%。四维超声对胎儿心脏畸形诊断的准确率明显高于二维超声(χ~2=21.761,P<0.01);四维超声对胎儿心脏畸形诊断的灵敏度和特异度分别为93.28%、95.12%,高于二维超声。结论四维超声在产前胎儿心脏筛查中具有较高的应用价值,对胎儿心脏畸形筛查的正确率较二维超声高。

Objective To investigate the value of two-dimensional versus four-dimensional echocardiography in prenatal fetal heart screening. Methods A retrospective analysis was performed for the clinical data of pregnant women who underwent prenatal fetal heart screening in our hospital from August 2014 to October 2016, and all these pregnant women underwent two-dimensional and four-dimensional echocardiography. The detection rate of fetal heart malformation was determined, and two-dimensional and four-dimensional echocardiography were compared in terms of accuracy, specificity, and sensitivity. Results Of all 4 500 high-risk pregnant women who underwent prenatal screening, 66 were found to have fetal heart malformation, among whom 10 had tetralogy of Fallot,7 had persistent truncus arteriosus, 5 had double outlet of the right ventricle, 3 had interruption of the inferior vena cava, 6 had atrioventricular septal defect, 2 had transposition of the great arteries, 12 had persistent left superior vena cava,4 had pulmonary valve stenosis,13 had ventricular septal defect, 3 had single ventricle, and 1 had Ebstein’s anomaly, resulting in a detection rate of heart malformation of 1.47%. Four-dimensional echocardiography had a significantly higher accuracy in the diagnosis of fetal heart malformation than the two-dimensional echocardiography （ χ^2=21.761, P 〈0.01）. Four-dimensional echocardiography had a sensitivity of 93.28% and a specificity of 95.12% in the diagnosis of fetal heart malformation, which were significantly higher than those of two-dimensional echocardiography. Conclusion Four-dimensional echocardiography has a high value in prenatal fetal heart screening, with a higher accuracy than two-dimensional echocardiography.