孕妇超声心动图联合血清TSP-1、Lp-PLA2检测诊断胎儿先天性心脏病效果

Diagnostic efficacy of echocardiography combined with maternal serum thrombospondin-1 and lipoprotein-associated phospholipase A2 levels of pregnant women for their fetal congenital heart disease

目的:探究孕妇超声心动图联合血清血小板反应蛋白-1(TSP-1)、脂蛋白相关磷脂酶A2(Lp-PLA2)检测诊断胎儿先天性心脏病(CHD)效能。方法:选择2022年5月-2023年5月在本院产前检查疑似胎儿心脏异常孕妇157例,根据妊娠结局是否发生CHD分为对照组(n=85)和CHD组(n=72)。采用彩色多普勒超声系统对孕早期胎儿进行心脏检查并记录主动脉血流参数和肺动脉血流参数,检测血清TSP-1、Lp-PLA2水平;Pearson相关性分析TSP-1、Lp-PLA2水平与血流参数相关性;多因素logistic回归分析胎儿发生CHD的影响因素;受试者工作特征(ROC)曲线分析超声心动图联合TSP-1、Lp-PLA2水平对胎儿发生CHD的诊断价值。结果:CHD阳性CHD组检出48例、对照组检出3例;与对照组相比,CHD组ESRV、VRI、PVmax/AVmax以及血清TSP-1、Lp-PLA2水平升高,PSV、PSV/ESRV、ET、ACT下降;血清TSP-1、Lp-PLA2水平与ESRV、VRI、PVmax/AVmax呈正相关,与PSV、PSV/ESRV、ET、DT、ACT呈负相关;TSP-1、Lp-PLA2水平升高是胎儿发生CHD的独立危险因素(均P<0.05)。超声心动图、血清TSP-1、Lp-PLA2单独诊断胎儿发生CHD的曲线下面积(AUC)分别为0.816、0.811、0.806,3项联合诊断的AUC为0.950,优于各自单独诊断(均P=0.000),其敏感度84.7%、特异度94,3%。结论:CHD组血清TSP-1、Lp-PLA2水平异常升高,两者与胎儿主动脉血流参数和肺动脉血流参数具有相关性,其水平升高是胎儿发生CHD的独立危险因素,超声心动图联合TSP-1、Lp-PLA2诊断胎儿发生CHD有较高临床价值。

Objective:To explore the diagnostic efficacy of echocardiography combined with maternal serum thrombospondin-1(TSP-1)and lipoprotein-associated phospholipase A2(Lp PLA2)levels of pregnant women for their fetal congenital heart disease(CHD).Methods:157 pregnant women with the suspected fetal heart abnormalities by the antenatal examination from May 2022 to May 2023 were selected as the study subjects.According to the pregnancy outcomes,these women were divided into control group(85 women without fetal CHD)and study group(72 women with fetal CHD)based on whether the fetal CHD occurred or not.The fetal heart of the pregnant women was examined by color Doppler ultrasound system during the first trimester of pregnancy,and the fetal aortic and pulmonary artery blood flow parameters were recorded.The serum TSP-1 and Lp-PLA2 levels of the women were detected.Pearson correlation analysis was used to analyze the correlation between the TSP-1,Lp-PLA2 levels of the women and their fetal aortic and pulmonary artery blood flow parameters values.Multivariate logistic regression was used to analyze the influencing factors of the fetal CHD occurrence.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the echocardiography results combined with the TSP-1 and Lp-PLA2 levels of the women for their fetal CHD.Results:There were 48 women with fetal CHD in the study group and 3 women with fetal CHD in the control group.The values of ESRV,VRI and PVmax/AVmax,and the serum TSP-1 and Lp-PLA2 levels of the women in the study group were significantly higher than those of the women in the control group,while the values of PSV.PSV/ESRV,ET and ACT of the women in the study group were significantly lower.The serum TSP-1 and Lp-PLA2 levels of the women with fetal CHD were positively correlated with their ESRV,VRI and PVmax/AVmax values,while were negatively correlated with their PSV,PSV/ESRV,ET,DT and ACT values.The increased levels of TSP-1 and Lp-PLA2 of the pregnant women with were the independent risk factors of their fetal CHD occurrence(all P<0.05).The area under the curve(AUC)of the echocardiography results,the serum TSP-1 level and the Lp-PLA2 level of the women for diagnosing their fetal CHD were 0.816,0.811,and 0.806,respectively.The AUC of the combined the echocardiography results and the levels of the serum TSP-1 and the Lp-PLA2 of the women for diagnosing their fetal CHD was 0.950,and which was significantly higher than that of the echocardiography results,the serum TSP-1 level or the Lp-PLA2 level alone(all P=0.000).The sensitivity and the specificity of the combined the echocardiography results and the levels of the serum TSP-1 and the Lp-PLA2 of the women for diagnosing their fetal CHD were 84.7%and 94.3%.Conclusion:The levels of TSP-1 and Lp-PLA2 of the pregnant women with fetal CHD increase abnormally,which are correlated with the fetal aortic and pulmonary blood flow parameters.The elevated levels of TSP-1 and Lp-PLA2 of the pregnant women are the independent risk factors of their fetal CHD occurrence.The combined the echocardiography results and the levels of the serum TSP-1 and the Lp-PLA2 of the women for diagnosing their fetal CHD has higher clinical value.