z-score值联合节段分析法诊断胎儿圆锥动脉干畸形的研究

Research on the diagnosis of fetal conotruncal defects using z-score combined segmental analysis method

目的:探究超声心动图z-score值联合节段分析法在产前诊断胎儿心脏圆锥动脉干畸形中的价值。方法:选取2020年1月—2021年1月我院行胎儿心脏超声检查正常的胎儿1896例,构建大动脉各节段的孕周(GA)—z-score模型,选取2021年5月-2023年4月我院超声科进行胎儿心脏超声检查的1989例胎儿为研究对象,测量胎儿主动脉瓣环(AV)、升主动脉(AAO)、主动脉弓(ARCH)、降主动脉(DAO)、主动脉峡部、肺动脉瓣环(PV)、主肺动脉(MPA)、左肺动脉(LPA)、右肺动脉(RPA)内径,计算胎儿大动脉血管内径z-score值,结合节段分析法,诊断胎儿圆锥动脉干发育畸形。结果:共检出正常胎儿1927例,胎儿圆锥动脉干畸形62例,其中法洛四联症15例,完全性大动脉转位9例,右室双出口7例,主动脉增宽2例,主动脉缩窄6例,肺动脉增宽10例,肺动脉狭窄4例,主动脉瓣狭窄、肺动脉增宽合并永存左上腔静脉1例,双主动脉弓2例,主动脉弓离断1例,永存动脉干1例,肺动脉闭锁1例,右位主动脉弓并左锁骨下动脉迷走3例,误诊2例,漏诊1例,诊断灵敏度98.4%,特异度99.9%,阳性预测值96.8%,阴性预测值99.9%。z-score值联合节段分析法与二维超声联合节段分析法诊断结果具有统计学差异。结论:采用超声心动图z-score值联合节段分析法诊断胎儿圆锥动脉干畸形的类型,评估病变程度以及预后具有显著性,对指导优生优育具有重要意义。

Objective:To explore the diagnostic value of the combined method of ultrasound echocardiography z-score and segmental analysis in prenatal screening of fetal aortic conal artery malformations.Methods:A total of 1896 fetuses with normal fetal echocardiography examination in Weifang People's Hospital from January 2020 to January 2021 were selected.A gestational age(GA)-z-score model for each segment of the great arteries was constructed.From May 2021 to April 2023,1989fetuses who underwent fetal echocardiography examination were selected as the study subjects.The diameters of the fetal aortic valve ring(AV),ascending aorta(AAO),aortic arch(ARCH),descending aorta(DAO),aortic isthmus pulmonary valve ring(PV),main pulmonary artery(MPA),left pulmonary artery(LPA),and right pulmonary artery(RPA)were measured.The z-score values of the fetal great artery vessels were calculated,and combined with the segmental analysis method to diagnose conotruncal defects.Results:A total of 1927 normal fetuses and 62 cases of fetal aortic conal artery malformations were detected.Among them,there were 15 cases of Tetralogy of Fallot,9 cases of complete transposition of the great arteries,7 cases of double outlet right ventricle,2 cases of aortic dilatation,6 cases of aortic stenosis,10 cases of pulmonary artery dilatation,4 cases of pulmonary artery stenosis,1 case of aortic valve stenosis combined with pulmonary artery dilatation and persistent left superior vena cava,2 cases of double aortic arch,1 case of interrupted aortic arch,1 case of persistent truncus arteriosus,1 case of pulmonary artery atresia,3 cases of right aortic arch with left subclavian artery and vagus nerve,2 misdiagnoses,and 1missed diagnosis.The sensitivity was 98.4%,specificity was 99.9%,positive predictive value was 96.8%,and negative predictive value was 99.9%.There was a statistical difference between the diagnosis results of z-score combined with segmental analysis method and two-dimensional ultrasound combined with segmental analysis method.Conclusion:The use of ultrasound echocardiography z-score combined with segmental analysis method for diagnosing the type of fetal conotruncal defects,evaluating lesion severity,and prognosis assessment has significant accuracy,which is of great importance for guiding eugenics and eugenic reproduction.