胎儿心脏圆锥动脉干畸形的非遗传相关因素分析

Non-inherited relevant factors of fetal heart conotruncal defects

目的探讨胎儿圆锥动脉干畸形的母体及胎儿相关因素。方法入组2018年5月至2019年9月于首都医科大学附属北京安贞医院进行胎儿超声心动图检查、且其胎儿诊断为圆锥动脉干畸形的孕妇(胎儿异常组,n=158),并连续入组同期胎儿心脏超声提示正常的孕妇(胎儿正常组,n=485)。收集孕妇的社会人口统计学和生活方式特征以及胎儿因素。使用逐步Logistic回归分析来评估各种因素与胎儿圆锥动脉干畸形之间的关系。结果胎儿异常组孕妇年龄略低于胎儿正常组孕妇,检查时的孕周小于胎儿正常组(P均<0.05)。另外,胎儿异常组孕妇孕早期上呼吸道感染及精神应激的比例高于胎儿正常组(P均<0.05)。胎儿圆锥动脉干畸形中法洛四联症占39.2%、右室双出口18.4%、完全型大动脉转位或矫正型大动脉转位占15.8%,肺动脉闭锁合并室间隔缺损占13.9%,共同动脉干占6.3%,主动脉弓离断占6.3%。逐步Logistic回归分析显示母体孕早期上呼吸道感染(OR=1.97,95%CI:1.14~3.40,P=0.016)和精神应激(OR=3.74,95%CI:1.02~13.8,P=0.047)是胎儿圆锥动脉干畸形的独立相关因素。结论孕早期上呼吸道感染与精神应激与胎儿圆锥动脉干畸形相关。因此,对于患有这些因素的女性,应加强孕期管理和产前咨询,一定程度上可降低胎儿圆锥动脉干畸形的发生。

Objective To investigate the maternal and fetal factors related to fetal heart conotruncal defects(CTD).Methods Pregnant women received fetal echocardiography were chosen from Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to Sept.2019,and divided into CTD group(n=158)and normal group(n=485).The characteristics of sociodemography and lifestyle,and fetal factors were collected in 2 groups.The relationship between different factors and CTD was reviewed by using Logistic stepwise regression analysis.Results The age of pregnant women was slightly lower,and gestational weeks were less in CTD group than those in normal group(all P<0.05).The percentages of pregnant women with upper respiratory tract infection and mental stress during early pregnancy were higher in CTD group than those in normal group(all P<0.05).Among CTD,tetralogy of Fallot accounted for 39.2%,double outlet right ventricle for 18.4%,complete transposition of great arteries or corrective transposition of great arteries for 15.8%,pulmonary atresia complicated by ventricular septal defect for 13.9%,truncus arteriosus for 6.3%and aortic arch interruption for 6.3%.The results of Logistic stepwise regression analysis showed that maternal upper respiratory tract infection(OR=1.97,95%CI:1.14~3.40,P=0.016)and mental stress(OR=3.74,95%CI:1.02~13.8,P=0.047)during early pregnancy were independent factors of CTD.Conclusion Maternal upper respiratory tract infection and mental stress during early pregnancy are correlated to CTD.Therefore,for women suffering from these diseases,pregnancy management and prenatal consultation should be strengthened,which can reduce CTD occurrence to a certain extent.