超声“四切面”法联合妊娠中期产妇血清Freeβ-hCG和uE3筛查胎儿严重先天性心脏病的研究

A Study on the Value of Combined Mid-Pregnancy Serum Freeβ-hCG and uE3 Screening for Severe Congenital Heart Disease in Pregnant Women Using the"Four-Plane"Method of Ultrasound

目的:探究超声“四切面”法联合妊娠中期孕妇血清游离人绒毛膜促性腺激素(Freeβ-hCG)和雌三醇(uE3)筛查胎儿严重先天性心脏病(CHD)的临床应用价值。方法:选择2020年1月到2021年6月我院行妊娠中期CHD筛查的孕妇97例,检测孕妇血清Freeβ-hCG和uE3水平,采用超声“四切面”法筛查CHD,分析超声“四切面”法联合血清Freeβ-hCG和uE3水平对CHD的诊断价值。结果:97例孕妇随访确诊为严重CHD 9例(9/97,9.28%);超声“四切面”法检查提示高危胎儿25例,其中4例确诊为严重CHD(4/25,16.00%);孕妇血清学检测提示高危胎儿36例,其中6例最终确诊为严重CHD(6/36,16.67%);超声“四切面”法联合孕妇血清学检测提示高危胎儿9例,其中5例确诊为严重CHD(5/9,55.56%)。超声“四切面”法筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为16.00%、93.51%、74.51%、44.44%和77.22%。孕妇血清Freeβ-hCG和uE3水平筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.31%、92.08%、66.67%和64.00%,二者联合筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.65%、92.08%、55.56%和91.09%。二者联合检测的诊断情况高于单一检测方法(P<0.05)。结论:超声“四切面”法对妊娠中期孕妇筛查严重CHD具有较高的诊断价值,联合孕妇血清Freeβ-hCG和uE3水平能进一步提高诊断准确度,具有较好的临床应用价值。

Objective:To investigate the clinical application value of the"four-plane"method of ultra-sound combined with mid-pregnancy maternal serum free human chorionic gonadotropin(Freeβ-hCG)and estriol(uE3)for screening severe congenital heart disease(CHD)in fetuses.Methods:A total of 97 preg-nant women who underwent mid-pregnancy CHD screening in our hospital from January 2020 to June 2021 were selected.The maternal serum Freeβ-hCG and uE3 levels were detected,and the"four-plane"method of ultrasound was used to screen for CHD.The diagnostic value of the"four-plane"method of ultrasound combined with serum Freeβ-hCG and uE3 levels for CHD was analyzed.Results:A total of 9 cases(9/97,9.28%)of severe CHD were confirmed by follow-up;25 cases of high-risk fetuses were detected by the"four-plane"method of ultrasound,of which 4 cases were confirmed to have severe CHD(4/25,16.00%);36 cases of high-risk fetuses were detected by maternal serum biochemical test,of which 6 cases were finally confirmed to have severe CHD(6/36,16.67%);and 9 cases of high-risk fetuses were detected by the com-bined"four-plane"method of ultrasound and maternal serum biochemical test,of which 5 cases were con-firmed to have severe CHD(5/9,55.56%).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the"four-plane"method of ultrasound for screening severe CHD were 16.00%,93.51%,74.51%,44.44%,and 77.22%,respectively.The sensitivity,specificity,accuracy,posi-tive predictive value,and negative predictive value of maternal serum Freeβ-hCG and uE3 levels for screening severe CHD were 55.56%,95.31%,92.08%,66.67%,and 64.00%,respectively.The sensitivity,speci-ficity,accuracy,positive predictive value,and negative predictive value of the combined screening for severe CHD were 55.56%,95.65%,92.08%,55.56%,and 91.09%,respectively.The diagnostic results of the combined detection were higher than those of the single detection method(P<0.05).Conclusion:The"four-plane"method of ultrasound has a high diagnostic value for screening severe CHD in pregnant women in mid-pregnancy.The combination of maternal serum Freeβ-hCG and uE3 levels can further improve the diagnostic accuracy and has good clinical application value.