产前二维超声联合四维超声检查在胎儿心脏畸形的临床诊断中的价值研究

Value of prenatal two-dimensional ultrasonography combined with four-dimensional ultrasonography in the clinical diagnosis of fetal heart malformations

目的:分析二维彩超与四维彩超在胎儿心脏畸形的筛查中的诊断效能,分析上述两种方法联合诊断胎儿心脏畸形的价值,已期提高胎儿心脏畸形诊断效能。方法:回顾性分析2019年1月至2021年1月期间收治的500例孕妇临床资料。纳入对象均经二维超声与四维超声筛查,并将引产或产后随访结果作为金标准。分析二维超声和四维超声单独与联合诊断时与金标准的一致性。结果:500例孕妇经引产与产后随访结果显示,心脏畸形52例,占比10.40%。经二维超声检查结果显示,灵敏度57.69%、特异度98.21%、阳性预测值78.95%、阴性预测值95.24%、准确率94.00%,二维超声检查与金标准的一致性Kappa值为0.635。四维超声检查结果显示,灵敏度63.46%、特异度98.44%、阳性预测值82.50%、阴性预测值95.87%、准确率94.80%,四维超声检查与金标准的一致性Kappa值为0.689。经二维超声联合四维超声检查结果显示,灵敏度92.31%、特异度99.55%、阳性预测值96.00%、阴性预测值99.11%、准确率98.80%,联合诊断与金标准的一致性Kappa值为0.934。结论:二维彩超与四维超声联合应用于胎儿心脏畸形筛查中,可显著提高诊断效能,降低漏诊、误诊风险。

Objective:To analyze the diagnostic efficacy of two-dimensional and four-dimensional color ultrasound in screening fetal heart malformations,and analyze the value of the combined diagnosis of the above two methods in order to improve the diagnostic efficacy of fetal heart malformations.Methods:Clinical data of 500 pregnant women admitted from January 2019 to January 2021 were retrospectively analyzed.All subjects were screened by 2D ultrasound and 4D ultrasound,and the results of induction of labor or postpartum follow-up were used as the gold standard.The consistency of two dimensional ultrasound and four dimensional ultrasound with gold standard was analyzed.Results:There were 52 cases(10.40%)of cardiac malformations in 500 pregnant women after induction of labor and postpartum follow-up.The results of two-dimensional ultrasound examination showed that the sensitivity was 57.69%,specificity 98.21%,positive predictive value was 78.95%,negative predictive value was 95.24%,and the accuracy was 94.00%.The Kappa value of two-dimensional ultrasound examination and gold standard was 0.635.The results of 4D ultrasound showed that the sensitivity was 63.46%,the specificity was 98.44%,the positive predictive value was 82.50%,the negative predictive value was 95.87%,and the accuracy rate was 94.80%.The Kappa value of 4D ultrasound and gold standard was 0.689.The results of 2D ultrasound combined with 4D ultrasound showed that the sensitivity was 92.31%,the specificity was 99.55%,the positive predictive value was 96.00%,the negative predictive value was 99.11%,and the accuracy was 98.80%.The Kappa value of the combined diagnosis and the gold standard was 0.934.Conclusion:The combined application of 2D color ultrasound and 4D ultrasound in the screening of fetal heart malformation can significantly improve the diagnostic efficiency and reduce the risk of missed diagnosis and misdiagnosis.