房室间隔缺损胎儿的超声心动图定量参数分析

Quantitative analysis of echocardiographic parameters for prenatal screening of atrioventricular septal defect

目的通过对胎儿超声心动图(FE)结构化数据的定量分析寻找产前诊断房室间隔缺损(AVSD)的关键筛查参数。方法回顾性收集首都医科大学附属北京安贞医院胎儿心脏病母胎医学会诊中心数据库2016年1月至2021年12月诊断的370例正常胎儿和96例AVSD胎儿的112个FE结构化参数。根据受试者工作特征曲线下面积(AUC),筛选出筛查效果最好的前6位参数并对6个参数的产前筛查效能进行评估。结果筛选出的6个参数均从FE的舒张末期四腔心切面获得;AUC最大的前6位参数依次为:舒张末期房室长度比值、舒张末期房室长度比值的Q值、收缩末期房室长度比值的Q值、收缩末期房室长度比值、舒张末期心室长度的Q值和舒张末期心室长度,AUC分别为0.92、0.92、0.86、0.84、0.84和0.81;在假阳性率为20%的范围内,6个参数对于AVSD产前筛查的敏感度依次为82%、82%、75%、67%、65%和71%。结论舒张末期房室长度比值及其Q值可以作为产前筛查AVSD的关键筛查参数,其中,舒张末期房室长度比值获取更容易且计算更方便。

Objective This study aimed to select the critical parameters for prenatal screening of atrioventricular septal defect(AVSD)through analyzing the quantitative parameters of fetal echocardiography(FE).Methods Totally 112 FE quantitative parameters of 96 AVSD fetuses and 370 normal fetuses diagnosed in our center between January 2016 and December 2021 were retrospectively analyzed.Based on the area under the receiver operating characteristic curve(AUC),the top six with the best screening effect were selected and the effectiveness of six parameters was analyzed.Results Among the 112 parameters,the top six with the largest AUC were the end diastolic atrioventricular length ratio,the quantile score(Q score)of the end diastolic atrioventricular length ratio,the Q score of the end systolic atrioventricular length ratio,the end systolic atrioventricular length ratio,Q score of the end diastolic ventricular length,and the end-diastolic ventricular length.The AUC were 0.92,0.92,0.86,0.84,0.84 and 0.81,respectively.Within the range of false positive rate of 20%,the sensitivities of six parameters for prenatal screening of AVSD were 82%,82%,75%,67%,65%and 71%,respectively.Conclusion The ratio of the end diastolic atrioventricular length and its Q score could be used as the critical parameters for prenatal screening of AVSD,with the former being easier to calculate and remember.