三维超声体积自动测量技术评估肺血减少型先天性心脏病胎儿肺体积变化

3D ultrasound volume automatic measurement for evaluation on lung volume changes in congenital heart disease fetuses with decreased pulmonary blood flow

目的采用三维超声计算机辅助虚拟脏器分析(VOCAL)技术观察肺血减少型先天性心脏病(CHD-DPBF)对胎儿肺体积发育的影响。方法收集41胎法洛四联症(TOF)胎儿(TOF组)和110胎正常胎儿(对照组),以二维超声估测胎儿孕周、体质量及心胸比(CTR),以三维超声VOCAL技术测量胎儿肺体积,计算超声肺重比(肺体积与体质量的比值)和肺体积与孕周比值,比较2组间的差异;评估胎儿肺体积与孕周的相关性。结果 TOF组胎儿孕周、估算体质量和肺体积与对照组比较差异无统计学意义(P均>0.05),TOF组胎儿CTR大于对照组(P<0.001),胎儿肺体积与孕周比值及超声肺重比小于对照组(P均<0.05)。TOF组及对照组胎儿肺体积与孕周均呈正相关(r=0.611、0.547,P均<0.001)。结论 CHD-DPBF胎儿超声肺重比及肺体积与孕周比值均低于正常胎儿,提示CHD-DPBF胎儿肺脏发育受到一定程度不良影响。

Objective To evaluate the impact of congenital heart disease with decreased pulmonary blood flow(CHDDPBF)on fetal lung volume development using 3Dultrasound virtual organ computer-aided analysis(VOCAL)technique.Methods Totally 41 fetuses with tetralogy of Fallot(TOF,TOF group)and 110 normal fetuses(control group)were enrolled.The fetal gestational age(GA),estimated fetal weight(EFW)and cardiothoracic ratio(CTR)were estimated using 2D ultrasound,while fetal lung volume(FLV)was estimated using 3D ultrasound VOCAL.FLV/EFW and FLV/GA were calculated and compared between the two groups.The correlation between FLV and GA was assessed.ResultsNo significant difference of GA,EFW nor FLV were found between the two groups(all P>0.05).CTR in TOF group significantly increased(P<0.001),FLV/GA and FLV/EFW significantly reduced compared with control group(both P<0.05).FLV was positively correlated with GA in both groups(r=0.611,0.547,both P<0.001).Conclusion FLV/EFW and FLV/GA values decrease in CHD-DPBF,suggest that the lung development of CHD-DPBF fetus has already been affected to some extent.