超声软指标在孕11~14周胎儿心脏结构异常临床诊断意义

Significance of ultrasonic soft indexes for diagnosing abnormal fetal cardiac structure during11-14 gestational weeks

目的:分析超声软指标在孕早期(孕11~14周)胎儿心脏结构临床诊断意义.方法:回顾性分析2017年5月-2020年9月本院产前检查107例单胎孕妇临床资料,均于孕11~14周超声检查,收集相关软指标参数并随访至妊娠事件结束,以最终结局为金标准分析超声检查软指标与临床诊断胎儿心脏畸形的符合情况.结果:超声诊断心脏畸形的敏感度为83.3%,特异度为97.8%,准确度为95.3%,阴阳预测值为96.7%,阳性预测值为88.2%,kappa值为0.829,与金标准具有较好的一致性(P<0.05);超声软指标检测异常率,心脏畸形胎儿高于心脏正常胎儿,≥30岁孕妇高于<30岁孕妇(均P<0.05);心脏三尖瓣反向血流、胎儿透明度厚度增厚、静脉导管血流频谱异常及孕妇年龄≥30岁均与胎儿心脏异常存在相关性且均为独立危险因素(均P<0.05).结论:超声软指标应用于早孕期胎儿心脏畸形筛查有较高的临床诊断价值,有利于孕早期辅助判断胎儿心脏结构异常.

Objective: To study the clinical diagnostic significance of ultrasonic soft indexes for abnormal fetal cardiac structure during 11-14 gestational weeks. Methods: A retrospective analysis was performed on the clinical data of 107 pregnant women with singleton pregnancies who had received ultrasonic examination during 11-14 gestational weeks from May 2017 to September 2020. The ultrasonic soft indexes of these women were collected and were followed up to determine of their pregnancy. Base on the final pregnancy outcomes as the golden standard, the coincidence of soft indexes of ultrasonic examination and clinical diagnosis for fetal heart malformation was analyzed. Results: The sensitivity, the specificity, and the accuracy, the negative predictive value, the positive predictive value, and Kappa value of ultrasonic diagnosis of fetal cardiac malformation were 83.3%, 97.8%, 95.3%, 96.7%, 88.2%, and 0.829, respectively, which had better coincidence with the results of gold standard(P<0.05). The rate of abnormal soft indexes of ultrasonic examination of the fetus with heart malformation was significantly higher than that of the fetus with normal heart, and which of the pregnant women ≥30 years old was significantly higher than that of the pregnant women <30 years old(all P<0.05). TR reverse blood flow, NT thickening, abnormal DV blood flow spectrum, and maternal age ≥30 years old were all correlated with the fetal heart abnormalities and were all the independent risk factors of the fetal heart abnormalities(all P<0.05). Conclusion: The ultrasonic soft indexes for diagnosing fetal heart abnormalities during the first trimester of pregnancy has high efficiency, which is conducive to early accurate judge the fetal cardiac structure abnormalities.