颈部透明层厚度、心脏三尖瓣反流和静脉导管血流联合Z评分对胎儿先天性心脏病的诊断效能分析

Diagnostic efficacy of nuchal translucency,tricuspid regurgitation,and ductus venosus combined with Z-score in fetal congenital heart disease

目的研究颈部透明层厚度(NT)、心脏三尖瓣反流(TR)和静脉导管血流(DV)联合胎儿心脏测量参数Z评分对胎儿先天性心脏病的诊断效能。方法采用2015年1月至2020年2月在内蒙古医学院附属医院进行孕早期新生儿筛查的6217例孕妇作为研究对象,根据引产与分娩共确证胎儿患有先心病分为观察组和对照组,分别对两组胎儿的NT、TR、DV以及心脏测量参数Z评分进行比较。分析NT、TR、DV与Z评分的联合对胎儿先天性心脏病的诊断效能。结果观察组胎儿的NT、TR、DV异常率均高于对照组(χ^(2)=1953.577、1805.085、1339.066,均P<0.001)。在以双顶径的预测中,观察组胎儿的主动脉Z评分低于对照组(0.012±0.001 vs 0.023±0.002,t=84.259,P<0.001),肺动脉Z评分高于对照组(0.035±0.002 vs 0.025±0.003,t=38.623,P=0.000);在以股骨长的预测中,观察组胎儿的主动脉Z评分(0.022±0.003 vs 0.037±0.004,t=38.172,P<0.001)以及肺动脉Z评分(0.031±0.005 vs 0.039±0.003,t=12.474,P<0.001)低于对照组;在以实际孕周的预测中,观察组胎儿的主动脉Z评分(0.013±0.001 vs 0.022±0.002,t=68.939,P<0.001)以及肺动脉Z评分(0.014±0.002 vs 0.019±0.003,t=19.312,P<0.001)低于对照组。NT、TR、DV与Z评分联合诊断胎儿先天性心脏病的灵敏度为93.44%,显著优于单独诊断;NT、TR、DV与Z评分联合诊断胎儿先天性心脏病的受试者工作特征曲线下面积为0.892,显著高于单独检测(95%CI:0.654~0.912,P<0.001)。结论NT、TR、DV联合胎儿心脏测量参数Z评分对胎儿先天性心脏病具有积极的诊断意义。

Objective To evaluate the diagnostic efficacy of nuchal translucency(NT),tricuspid regurgitation(TR),and ductus venosus(DV)combined with Z-score in fetal congenital heart disease.Methods A total of 6217 pregnant women who underwent early-trimester neonatal screening at the Affiliated Hospital of Inner Mongolia Medical College from January 2015 to February 2020 were selected as the research subjects.According to the co-confirmation of labor induction and delivery,the fetuses were divided into either an observation group or a control group.The NT,TR,and DV values and the cardiac measurement parameter Z-score of the fetuses were compared between the two groups.Results The abnormal rates of NT,TR,and DV in the observation group were all higher than those in the control group(χ^(2)=1953.577,1805.085,and1339.066,respectively,P<0.001).In the prediction with a double-top diameter,the aortic Z score of the observation group was lower than that in the control group(0.012±0.001 vs 0.023±0.002,t=84.259,P=0.000);the pulmonary artery Z score was higher than that of the control group(0.035±0.002 vs 0.025±0.003,t=38.623,P=0.000).In the prediction by femur length,the Z scores of the aorta and pulmonary artery of the fetus in the observation group were both lower than those in the control group(0.022±0.003 vs 0.037±0.004 and 0.031±0.005 vs 0.039±0.003,t=38.172 and 12.474,respectively,P<0.001).In the prediction with actual gestational age,the Z score of the aorta and pulmonary artery of the fetus in the observation group were both lower than those in the control group(0.013±0.001 vs 0.022±0.002 and 0.014±0.002 vs 0.019±0.003,t=68.939 and 19.312,respectively,P<0.001).The diagnostic sensitivity of the combination of NT,TR,and DV values with Z score for fetal congenital heart disease was 93.44%,which was significantly higher than that of any single index alone.The area under the receiver operating characteristic curve(AUC)of the combination of NT,TR,and DV values with Z score in diagnosis of congenital heart disease was 0.892,which was higher than that of any single index alone(95%CI:0.654~0.912,P<0.001).Conclusion NT,TR,and DV combined with the fetal heart measurement parameter Z-score has positive diagnostic significance for fetuses with congenital heart disease.