STIC技术联合常规超声心动图筛查胎儿先天性心脏畸形的价值及危险因素分析

Analysis of the value and risk factors of STIC technology combined with conventional echocardiography in screening fetal congenital heart malformations

目的研究时间-空间相关成像(STIC)技术结合常规超声心动图对胎儿先天性心脏畸形的临床诊断价值,并总结出易导致胎儿先天性心脏畸形的危险因素。方法选择2020年4月至12月于陕西中医药大学院附属医院超声诊断科行产前检查的1624例孕妇,运用STIC技术结合常规超声心动图进行检查,检查前孕妇填写高危因素统计表并对筛查的高危因素进行单因素和多因素Logistic回归分析。结果1624例胎儿经金标准(产后随访或尸检)显示25例胎儿先天性心脏畸形,STIC技术结合常规超声心动图检出25例胎儿先天性心脏畸形,总检出率为1.54%(25/1624),1例室间隔缺损产后随访为正常心脏。STIC技术结合常规超声心动图诊断先天性心脏畸形的灵敏度为96.00%(24/25),特异度为99.94%(1598/1599),准确度为99.88%(1622/1624)。单因素分析结果显示,先天性心脏畸形组和正常组孕妇的家族遗传史、不良环境接触史、妊娠异常史、妊娠期糖尿病及妊娠早期上呼吸道感染占比比较,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,排除了年龄和妊娠次数的干扰,家族遗传史、不良环境接触史、妊娠异常史、妊娠期糖尿病及妊娠早期上呼吸道感染是胎儿先天性心脏畸形的危险因素(P<0.05);交互作用分析结果显示,排除了年龄和妊娠次数干扰,不良环境接触史和妊娠早期上呼吸道感染、妊娠期糖尿病和妊娠早期上呼吸道感染存在交互作用(P<0.05)。结论STIC技术结合常规超声心动图是筛查胎儿先天性心脏畸形准确性较高的方法,其中STIC技术具有直观、立体、不受体位干扰等优点,可作为常规超声心动图的辅助检查工具。家族遗传史、不良环境接触史、妊娠异常史、妊娠期糖尿病及妊娠早期上呼吸道感染是胎儿先天性心脏畸形的危险因素。不良环境接触史和妊娠早期上呼吸道感染、妊娠期糖尿病和妊娠早期上呼吸道感染存在交互作用。

Objective To study the clinical diagnostic value of spatiotemporal image correlation(STIC)technology combined with conventional echocardiography for fetal congenital heart malformations,and summarize the risk factors that can easily cause fetal congenital heart malformations.Methods A total of 1624 pregnant women who underwent prenatal examination in the ultrasound diagnostic department of Affiliated Hospital of Shaanxi University of Chinese Medicine from April to December 2020 were selected.STIC technology combined with conventional echocardiography was used for examination.Before examination,the pregnant women filled in the statistical table of high-risk factors,and the univariate and multivariate Logistic regression analysis of the screened risk factors were conducted.Results The gold standard(postpartum follow-up and autopsy)of 1624 fetuses showed that 25 fetuses had congenital heart malformations.STIC technology combined with conventional echocardiography detected 25 fetuses with congenital heart malformations,with a total detection rate of 1.54%(25/1624).One case with ventricular septal defect was found to have normal heart after postpartum follow-up.The sensitivity,specificity and accuracy of STIC technology combined with conventional echocardiography in the diagnosis of congenital heart malformations were 96.00%(24/25),99.94%(1598/1599)and99.88%(1622/1624).The results of univariate analysis showed that there were significant differences in proportions of pregnant women between the congenital heart malformations group and the normal group in terms of family genetic history,adverse environmental contact history,abnormal pregnancy history,gestational diabetes mellitus and upper respiratory tract infection in early pregnancy(P<0.05);the results of multivariate Logistic regression analysis showed that,excluding the interference of age and number of pregnancies,family genetic history,adverse environmental contact history,abnormal pregnancy history,gestational diabetes mellitus and upper respiratory tract infection in early pregnancy were the risk factors of fetal congenital heart malformations(P<0.05);the results of interaction analysis showed that,excluding the interference of age and number of pregnancies,there were interaction between adverse environmental contact history and upper respiratory tract infection in early pregnancy,gestational diabetes mellitus and upper respiratory tract infection in early pregnancy(P<0.05).Conclusion STIC technology combined with conventional echocardiography is a highly accurate method for screening fetal congenital heart malformations.STIC technology has the advantages of being intuitive,three-dimensional and free from body position interference,which can be used as an auxiliary examination tool of conventional echocardiography.Family genetic history,adverse environmental contact history,abnormal pregnancy history,gestational diabetes mellitus and upper respiratory tract infection in early pregnancy are the risk factors of fetal congenital heart malformations.There are interaction between adverse environmental contact history and upper respiratory tract infection in early pregnancy,gestational diabetes mellitus and upper respiratory tract infection in early pregnancy.