超声监测孕早期胎儿心轴角度与先天性心脏病关系

Relationship between the fetal heart axis angle monitored by ultrasound during the first trimester of pregnancy and fetal congenital heart disease

目的:研究超声监测孕早期胎儿心轴角度与胎儿先天性心脏病关系。方法:将2017年6月—2019年6月本院行颈项透明层厚度测量的孕11~13+6周胎儿纳为研究对象,经后期随访确诊先心病32例(先心病组),正常者80例(正常组);按照国际妇产超声学会(ISUOG)指南标准,于四腔心切面测量胎儿心轴角度,分析心轴角度诊断孕早期胎儿先天性心脏病的价值。结果:32例先天性心脏病中占比较高的3种心脏病种类分别为法洛四联症(34.4%)、室间隔缺损(21.9%)、单心房与单心室(18.8%);二维超声联合多普勒血流成像心脏轴检出率(88.4%)高于二维超声(63.4%),先心病组患儿心轴角度(51.36±11.71)°高于正常组(41.15±10.03)°,先心病组心轴角异常检出率(40.6%)高于正常组(1.3%)(均P<0.05)。绘制ROC曲线,孕早期胎儿心轴角度≥44.74°时诊断先天性心脏病的曲线下面积(AUC)=0.777,其灵敏度75.0%、特异度73.7%、95%CI(0.682~0.872)。结论:孕早期二维超声联合彩色多普勒血流检测能有效提高胎儿心轴检出效果,心轴角度异常对预测胎儿先天性心脏病有良好价值。

Objective:To investigate the relationship between the fetal heart axis angle monitored by ultrasound during the first trimester of pregnancy and fetal congenital heart disease.Methods:Fetuses who received fetal nuchal translucency thickness measurement by ultrasound during 11-13+6 gestational weeks were enrolled in this study,which included 32 cases with congenital heart disease in group A and 80 cases without congenital heart disease according to the later followed up results.Fetal cardiac axis was measured on the four-chamber view of the heart based on the guidelines of the International society of ultrasound and obstetrics and gynecology(ISUOG).Then the value of the axial angle for diagnosing fetal congenital heart disease during the first trimester of pregnancy was analyzed.Results:In group A,the three types of heart disease accounted for the highest proportion were TOF(34.4%),VSD(21.9%),and SA and SV(18.8%).The detection rate of two-dimensional ultrasound combined with Doppler blood flow imaging for heart axis was 88.4%,which was significant higher than that(63.4%)of two-dimensional ultrasound alone(P<0.05).The angle of the heart axis of fetus with congenital heart disease was 51.36±11.71°,which was significant higher than that(41.15±10.03°)of normal fetus.The detection rate of abnormal angle of heart axis of fetus with congenital heart disease was 40.6%,which was significant higher than that(1.3%)of normal fetus(all P<0.05).When the heart axis≥44.74°,ROC curve found that the AUC,the sensitivity,and the specificity for diagnosing fetal congenital heart disease during the first trimester of pregnancy were 0.777,75.0%,and 73.7%(95%CI 0.682-0.872),respectively.Conclusion:Two-dimensional ultrasound combined with color Doppler blood flow examination can effectively improve the detection rate of heart axis angle of fetus,and the abnormal heart axis angle of fetus has value for predicting their congenital heart disease.