16~40周正常胎儿卵圆孔瓣膨出指数和开放角度正常参考值的研究

Study on establishing the reference range of atrial septal excursion index and foramen ovale membrane angle in normal fetuses aged 16-40 weeks

目的建立16~40周正常胎儿房间隔卵圆孔瓣膨出指数(ASEI)及卵圆孔瓣开放角度的正常参考值范围,分析正常胎儿ASEI与卵圆孔瓣开放角度之间的相关性。方法选取2021年1-6月于浙江大学医学院附属邵逸夫医院超声科连续接受胎儿超声心动图检查、孕周为16~40周的正常单胎胎儿378例,并将成功测量的349例胎儿纳入研究。所有胎儿在完成系统切面胎儿超声心动图检查后,在四腔心切面上测量卵圆孔开口直径和卵圆孔瓣开放角度,测量卵圆孔瓣从房间隔基底部偏移至左心房游离壁的最大距离和左心房横径,计算ASEI,比较不同孕周组间ASEI、卵圆孔瓣开放角度、卵圆孔开口直径的差异。采用Pearson法评价胎儿ASEI、卵圆孔瓣开放角度、卵圆孔开口直径之间的相关性。结果将349例胎儿根据孕周进行分组,其中16~20周17例,21~24周46例,25~28周114例,29~32周105例,33~36周31例,37~40周36例。ASEI的±s为0.4927±0.0597,95%CI为0.4864~0.4990,95%正常参考值范围为0.3757~0.6098,ASEI在不同孕周分组间差异有统计学意义(P<0.05)。卵圆孔瓣开放角度的±s为(44.03±5.48)°,95%CI为43.46~44.61°,95%正常参考值范围为33.29~54.78°,卵圆孔瓣开放角度在不同孕周分组间差异有统计学意义(P<0.05)。卵圆孔开口直径的±s为(4.32±1.30)mm,95%CI为4.18~4.45 mm,卵圆孔开口直径在不同孕周分组间差异有统计学意义(P<0.05),并且随着孕周增加逐渐增大。ASEI与卵圆孔瓣开放角度存在正相关(r=0.558,P<0.05)。卵圆孔开口直径与ASEI、卵圆孔瓣开放角度无相关性(r=-0.166、-0.084,均P>0.05)。结论建立了16~40周正常胎儿的ASEI及卵圆孔瓣开放角度的正常参考值范围,这些数据可能是通过卵圆孔评价舒张期心功能的有用参数。

Objective To establish the normal reference range of atrial septal excursion index(ASEI)and foramen ovale membrane angle in normal fetuses aged 16-40 weeks,and to analyze the correlation between ASEI and foramen ovale membrane angle in normal fetuses.Methods A total of 378 normal singletons with gestational ages of 16-40 weeks undergoing by fetal echocardiography were selected in the Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine,from January to June 2021,and 349 fetuses successfully finished all measurements.After all fetuses completed the systematic fetal echocardiography,fetal foramen ovale diameter and foramen ovale membrane angle were measured on the four chamber view.The maximum distance of foramen ovale valve from the base of atrial septum to the free wall of left atrium and the transverse diameter of left atrium were measured,and ASEI was calculated.The differences of ASEI,foramen ovale membrane angle and foramen ovale diameter of the groups with different gestational weeks were compared.The correlations among ASEI,foramen ovale membrane angle and foramen ovale diameter were analyzed by Pearson correlation analysis.Results All 349 fetuses were divided into 6 groups according to their gestational weeks,including 17 cases at 16-20 weeks,46 cases at 21-24 weeks,114 cases at 25-28 weeks,105 cases at 29-32 weeks,31 cases at 33-36 weeks and 36 cases at 37-40 weeks.The±s of ASEI was 0.4927±0.0597,95%CI was 0.4864-0.4990,95%normal reference value range was 0.3757-0.6098.Significant differences were found in ASEI among different groups(P<0.05).The±s of foramen ovale membrane angle was(44.03±5.48)°,95%CI was 43.46-44.61°,95%normal reference value range was 33.29-54.78°.Significant differences were found in the foramen ovale membrane angle among different groups(P<0.05).The±s of foramen ovale diameter was(4.32±1.30)mm,95%CI was 4.18-4.45 mm,the differences among different groups were significant(P<0.05)and foramen ovale diameter was found increased with the increase of gestational weeks.There was a significant positive correlation between ASEI and foramen ovale membrane angle(r=0.558,P<0.05).There was no correlation between foramen ovale diameter and ASEI and foramen ovale membrane angle(r=-0.166,-0.084;all P>0.05).Conclusions The normal reference ranges of ASEI and foramen ovale valve angle of normal fetuses aged 16-40 weeks was successfully established.These parameters may be useful for evaluating diastolic cardiac function by assessing foramen ovale.