超声心动图联合孕妇血清总胆汁酸和同型半胱氨酸水平检测对胎儿心脏病的早期诊断价值

The value of echocardiography combined with maternal serum total bile acid and homocysteine levels in the early diagnosis of fetal heart disease

目的探讨超声心动图联合孕妇血清总胆汁酸(TBA)和同型半胱氨酸(Hcy)水平检测对胎儿心脏病的早期诊断价值。方法选取2017年12月—2018年12月在金华市妇幼保健院产检的97例孕妇为研究对象,其中胎儿患有心脏病的孕妇52例为研究组,胎儿发育正常孕妇45例为对照组。采用酶法检测血清Hcy水平,采用第五代循环酶法检测血清TBA水平,应用GE Voluson E8型彩色多普勒超声仪进行超声心动图检查,采用多元Logistic回归分析影响胎儿心脏病的相关因素,采用受试者工作特征(ROC)曲线分析血清TBA、Hcy对胎儿心脏病的诊断价值。结果研究组孕妇血清TBA[(16.35±2.16)μmol/L]和Hcy[(17.52±3.85)μmol/L]水平均高于对照组[(4.59±1.13)μmol/L、(7.62±2.30)μmol/L],差异均有统计学意义(t=32.826、15.072,均P<0.05)。多元Logistic回归分析结果显示,血清TBA、Hcy水平是影响胎儿心脏病的危险因素(均P<0.05,OR>1)。ROC分析结果显示,血清TBA、Hcy及超声心动图对胎儿心脏病均具有一定的诊断价值,AUC分别为0.647、0.605及0.650。3项指标联合应用的灵敏度和特异度分别为0.769(40/52)和0.733(33/45)。结论超声心动图联合孕妇血清TBA、Hcy水平检测诊断胎儿心脏病具有无创、简便、灵敏度高及准确率高等特点,具有临床应用价值。

Objective To investigate the value of echocardiography combined with maternal serum total bile acid(TBA) and homocysteine(Hcy) levels in the early diagnosis of fetal heart disease.Methods A total of 97 pregnant women who were examined in Jinhua Maternal and Child Health Care Hospital from December 2017 to December 2018 were selected as the latest research.Among them,52 pregnant women with fetuses with heart disease were selected as the study group,and 45 pregnant women with normal fetal development were the control group.Enzymatic method was used to detect serum Hcy level,the fifth-generation circulating enzyme method was used to detect serum TBA level,GE Voluson E8 color Doppler ultrasound system was used for echocardiography,and multivariate Logistic regression analysis was used to analyze the effects of fetal heart disease.For related factors,the receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum TBA and Hcy for fetal heart disease.Results The serum TBA [(16.35±2.16)μmol/L] and Hcy(17.52±3.85)μmol/L] levels of pregnant women in the study group were higher than those in the control group [(4.59±1.13)μmol/L,(7.62±2.30)μmol/L],the differences were statistically significant(t=32.826,15.072,all P<0.05).The results of multivariate Logistic regression analysis showed that serum TBA and Hcy levels were risk factors for fetal heart disease(all P<0.05,OR>1).ROC analysis results showed that serum TBA,Hcy and echocardiography have certain diagnostic value,and the AUC were 0.647,0.605 and 0.650.The sensitivity and specificity of the combined application of the three indicators were respectively 0.769(40/52),0.733(33/45).Conclusion The combination of echocardiography and maternal serum TBA and Hcy levels in the diagnosis of fetal heart disease had the characteristics of non-invasive,simple,high sensitivity and high accuracy,and had clinical application value.