胎儿主动脉缩窄超声心动图诊断指标的综合评估

Comprehensive Evaluation of Echocardiographic Indicators for Fetal Coarctation of Aorta

目的本研究旨在综合分析胎儿主动脉缩窄(coarctation of the aorta,CoA)的相关超声心动图指标。方法回顾性分析2018年1月至2023年5月广东省人民医院产前超声心动图检查疑诊CoA存活胎儿204例的临床资料,提取产前超声心动图数据和患者资料。根据生后随访结果将研究对象分为真阳性组(A组)和假阳性组(B组)。通过Logistic回归分析筛选预测指标并建立确诊CoA列线图预测模型,按6:4随机将患者分为训练集和测试集,进行模型内部验证及效果评价。结果204例胎儿被纳入研究,其中A组95例(46.5%),B组109例(53.43%)。最终确定4个指标组成列线图模型,包括左心室Z值、主动脉远端横弓Z值、肺动脉主干与升主动脉比值、是否合并室间隔缺损。该模型具有一定预测能力和实用价值[曲线下面积(area under the curve,AUC)=0.888],在验证集中亦取得了良好的诊断效能(AUC=0.825),内部验证显示模型具有良好的预测能力和应用价值。结论本研究建立的列线图模型可作为应用简单且有效的工具,提高CoA的产前诊断准确性,促进围产期及生后的分层管理。

Objectives This study systematically evaluates echocardiographic indicators to enhance the prenatal diagnosis of fetal coarctation of the aorta(CoA),aiming to refine diagnostic methodologies and facilitate individualized management strategies.Methods A retrospective analysis of prenatal echocardiographic diagnosis was performed for fetuses with suspected CoA at Guangdong Provincial People's Hospital between January 2018 and May 2023.The subjects were classified into two groups based on postnatal outcomes:true-positive CoA cases(group A)and false-positive cases(group B).Predictive indicators for CoA were selected through regression analysis and a predictive nomogram model was developed.This model was subjected to internal validation and its diagnostic effectiveness was assessed through the areas under the curve(AUC)in both training and validation datasets.Results The analysis included 204 fetuses,with 95(46.5%)classified in group A and 109(53.43%)in group B.Logistic regression analysis identified 4 significant echocardiographic predictors that were used to construct the nomogram:the Z-score of the left ventricle,the Z-score of the distal transverse arch,the ratio of the main pulmonary artery to ascending aorta,and the presence of a ventricular septal defect.The predictive nomogram exhibited excellent diagnostic accuracy,with AUC values of 0.888 in the training set and 0.825 in the validation set,illustrating its substantial predictive strength and clinical applicability.Conclusions The developed nomogram model provides a simple powerful tool for the prenatal diagnosis of CoA,enabling more accurate predictions and facilitating targeted perinatal care.By incorporating comprehensive echocardiographic measurements,the model is set to advance prenatal diagnosis and improve postnatal management of CoA.