斑点追踪技术在胎儿主动脉缩窄诊断中的应用价值

Application of spot tracking technique in diagnosis of fetal aortic coarctation

目的:探寻斑点追踪技术在胎儿主动脉缩窄诊断中的应用价值。方法:回顾性选择产前行最后一次超声心动图检查诊断为可疑主动脉缩窄的胎儿96例,根据胎儿在产后第1周是否需要行主动脉缩窄手术,分为主动脉缩窄组与非主动脉缩窄组(假阳性);同时选择200名健康的胎儿作为对照组。对常规超声心动图参数进行测量后,使用二维图像进行斑点追踪技术分析,并测量和计算出相关参数。以对照组健康胎儿上述各项超声参数的均数和标准差为参考,按照公式计算出96例可疑主动脉缩窄胎儿的Z分数,最后进一步采用logistic回归分析识别出将主动脉缩窄组与假阳性组分开的变量。结果:96例可疑主动脉缩窄胎儿中有46.88%(45/96)产后确诊为主动脉缩窄,另外的53.13%(51/96)产后及跟踪随访1~2年后没有发生主动脉缩窄。主动脉缩窄组产后确诊存在其他心血管异常情况的胎儿占比明显高于假阳性组(P<0.05)。logistic回归分析获得了四腔心切面舒张末期大小、心室舒张末期大小、心室舒张末期形状、心室整体收缩功能、心室应变、心室基底-心尖收缩功能和左心室功能中的28个变量,这些变量能够有效将产后确诊为主动脉缩窄的胎儿与假阳性胎儿区分开(R^(2)=0.76)。该模型预测主动脉缩窄的敏感性为95.56%,特异性为96.08%,受试者工作特征曲线的曲线下面积为0.982(95%CI=0.832~0.998)。结论:对多个超声心动图测量值进行斑点追踪技术分析,有助于产前检查提示为可疑主动脉缩窄的胎儿进一步确诊,值得推荐。

Objective:To explore the application of spot tracking technique in the diagnosis of fetal aortic coarctation.Methods:Ninety-six fetuses diagnosed as suspected aortic coarctation by the last echocardiography before delivery were selected.According to the fetus needed aortic constriction or not in the first week after delivery,they were divided into aortic constriction group and non-aortic constriction group(false positive).At the same time,200 healthy fetuses were selected as the control group.After the conventional echocardiographic pa rameters were measured,the two-dimensional image was used for spot tracking technique analysis,and the relevant parameters were measured and calculated.The mean and standard deviation of the above-mentioned ultrasound parameters of healthy fetuses in the control group were used as the reference,the Z score of 96 fetuses with suspected aortic coarctation was calculated according to the formula.Finally,logistic regression analysis was used to identify the variables that separate the aortic coarctation group from the false positive group.Results:46.88%(45/96)of 96 fetuses with suspected coarctation of the aorta were diagnosed as the postpartum aortic coarctation.Another 53.13%(51/96)did not have aortic coarctation after delivery and 1-2-year follow-up.The proportion of fetuses diagnosed with other cardiovascular abnormalities in the aortic coarctation group was significantly higher than that in the false positive group(P<0.05).The logistic regression analysis identified 28 variable sets,R^(2)was 0.76.The model predicted aortic coarctation with the sensitivity of 95.56%,the specificity of 96.08%,and the area under the receiver operating characteristic curve of 0.982(95%CI=0.832-0.998).Conclusions:Spot tracking technique analysis of multiple echocardiographic measurements can help further diagnose the fetuses with suspected aortic coarctation in the prenatal examinations.