胎儿心脏定量分析技术评估获得性易栓症孕妇胎儿心脏形态和功能的临床价值

Clinical value of fetal heart quantification in evaluating fetal heart morphology and function in pregnant women with acquired thrombophilia

目的应用胎儿心脏定量分析技术(Fetal HQ)评估获得性易栓症孕妇胎儿心脏形态和收缩功能,探讨其临床应用价值。方法选取我院确诊为获得性易栓症的孕妇24例(病例组)和同期就诊的健康孕妇40例(对照组),应用频谱多普勒测量胎盘功能相关参数,包括脐动脉收缩期峰值流速与舒张末期峰值流速比值(UA S/D)、脐动脉搏动指数(UA PI)、大脑中动脉搏动指数(MCA PI)、静脉导管搏动指数(DV PI)、脑胎盘比值;应用Fetal HQ测量胎儿心脏形态参数[整体球形指数(GSI)]和功能参数[左、右室整体纵向应变(LVGLS、RVGLS)、面积变化分数(LVFAC、RVFAC)、游离壁应变(LVFWS、RVFWS)及左室间隔壁应变(LVSWS)、左室射血分数(LVEF)],比较两组上述参数的差异;分析胎盘功能参数与Fetal HQ参数的相关性。结果病例组胎儿UA S/D高于对照组,差异有统计学意义(P=0.007);两组胎儿UA PI、MCA PI、DV PI、脑胎盘比值比较,差异均无统计学意义。病例组胎儿RVGLS、RVFAC、RVFWS均较对照组减低,差异均有统计学意义(均P<0.05);两组胎儿GSI、LVEF、LVGLS、LVFAC、LVFWS、LVSWS比较,差异均无统计学意义。相关性分析显示,病例组胎儿UA S/D与RVGLS、RVFAC、RVFWS均呈负相关(r=-0.534、-0.624、-0.570,均P<0.05)。结论Fetal HQ可准确评估获得性易栓症孕妇胎儿心脏形态和右室收缩功能,具有较好的临床应用价值。

Objective To evaluate the fetal heart morphology and systolic function in pregnant women with acquired thrombophilia by fetal heart quantification(Fetal HQ),and to explore its clinical application value.Methods A total of 24 pregnant women diagnosed with acquired thrombophilia(case group)and 40 healthy pregnant women during the same period(control group)in our hospital were selected,and the related parameters of placental function were detected by spectral Doppler,including the ratio of peak systolic velocity to peak diastolic velocity of umbilical artery(UA S/D),umbilical artery pulsatility index(UA PI),middle cerebral artery pulsatility index(MCA PI),ductus venosus pulsatility index(DV PI),cerebral placental ratio.Fetal HQ was used to measure fetal heart morphological parameters[global spherical index(GSI)]and functional parameters[left and right ventricular global longitudinal strain(LVGLS,RVGLS),area change fraction(LVFAC,RVFAC),free wall strain(LVFWS,RVFWS),left ventricular septal wall strain(LVSWS),left ventricular ejection fraction(LVEF)],and the differences of the above parameters between the two groups were compared.The correlation between placental functional parameters and Fetal HQ parameters were analyzed.Results The fetal UA S/D in the case group was higher than that in the control group,and the difference was statistically significant(P=0.007).There were no significant difference in fetal UA PI,MCA PI,DV PI and cerebral placental ratio between the two groups.The fetal RVGLS,RVFAC and RVFWS in the case group were significantly lower than those in the control group,and the differences were statistically significant(all P<0.05).There were no significant difference in fetal GSI,LVEF,LVGLS,LVFAC,LVFWS and LVSWS between the two groups.Correlation analysis showed that fetal UA S/D in the case group was negatively correlated with RVGLS,RVFAC and RVFWS(r=-0.534,-0.624,-0.570,all P<0.05).Conclusion Fetal HQ could accurately assess the fetal heart morphology and systolic function in pregnant women with acquired thrombophilia,which has good clinical application value.