产前超声三血管气管切面检查对胎儿心脏大血管发育的诊断效能研究

Study on the Diagnostic Efficacy of Prenatal Ultrasound Triple Vessel Tra⁃cheal Section on Fetal Cardiac Macrovascular Development

目的 探讨超声三血管气管切面(three-vessel tracheal section, 3VT)检查对胎儿心脏大血管发育的诊断效能。方法 回顾性分析2020年1月-2021年12月福建省妇幼保健院收治的31 346名中孕期孕妇的临床资料,所有孕妇均采用超声3VT检查,对胎儿心脏大血管发育情况进行评估与畸形筛查。以产后检查或引产尸解结果为诊断金标准,采用ROC曲线分析超声3VT产前检查诊断胎儿心脏大血管畸形的价值,计算超声3VT产前检查诊断不同类型胎儿心脏大血管畸形的检出率。结果 经产后检查或引产尸解确诊胎儿心脏大血管畸形725例,经产前超声3VT检查正确诊断674例;产前超声3VT检查诊断胎儿心脏大血管畸形的符合率为96.88%(30 369/31 346),灵敏度为92.97%(674/725),特异度为96.98%(29 695/30 621),阳性预测值为42.13%(674/1 600),阴性预测值为99.83%(29 695/29 746)。ROC曲线显示,产前超声3VT检查诊断胎儿心脏大血管畸形的AUC为0.913(95%CI∶0.865~0.956)。结论 产前超声3VT检查能够准确评估胎儿心脏大血管畸形情况与类型,操作简便且可重复性好。

Objective To investigate the diagnostic efficacy of ultrasound three-vessel tracheal section(3VT)examination on fetal cardiac macrovascular development.Methods Retrospective analysis of clinical data from January 2020 to December 2021 of 31346 mid-trimester pregnant women admitted to Fujian Provincial Maternal and Child Health Hospital,all of whom were examined by ultrasound 3VT to assess fetal cardiac macrovascular development and screen for malformations.The results of postnatal examination or induced labor autopsy were used as the diagnostic gold standard,and the ROC curve was used to analyze the value of ultrasound 3VT prenatal examination in diagnosing fetal cardiac macrovascular malformations,and the detection rate of ultrasound 3VT prenatal examination in diagnosing different types of fetal cardiac macrovascular malformations was calculated.Results There were 725 cases of fetal cardiac macrovascular malformation confirmed by postnatal examination or induced labor autopsy,and 674 cases were correctly diagnosed by prenatal ultrasound 3VT examination.The compliance rate of prenatal ultrasound 3VT examination for the diagnosis of fetal cardiac macrovascular malformation was 96.88%(30369/31346),sensitivity was 92.97%(674/725),specificity was 96.98%(29695/30621),positive predictive value was 42.13%(674/1600),and negative predictive value was 99.83%(29695/29746).The ROC curve showed that the AUC of prenatal ultrasound 3VT for the diagnosis of fetal cardiac macrovascular malformations was 0.913(95%CI∶0.865-0.956).Conclusion Prenatal ultrasound 3VT can accurately assess the condition and type of fetal cardiac macrovascular malformation,and is easy to perform and reproducible.