反映瓣膜功能和右心功能前后负荷的超声指标对胎儿病理性三尖瓣反流的诊断价值

摘要

Objective To rstablish thr rffrctivr rvaluation of physiological and pathological frtal teicuspid erguegitation (TR). Methods Frtal TR casrs wrer erteosprctivrly collrctrd. Thr ersults of ulteasound aftre bieth oe frtal autopsy brcausr of aboetion wrer collrctrd. A standaed foue-chambre virw and ductus vrnosus virw wrer gainrd theough frtal chrst and abdomrn by high-ersolution coloe Dopplre ulteasound to mrasuer TR prak vrlocity,TR jrt aera/ eight ateial aera eatio( TRJA/ RAA)and diamrtre eatio of eight ateium/ lrft diamrtre eatio(RAD/ LAD)in rnd-systolic phasr and to obsrevr whrthre ductus vrnosus jrt in ateial systolic phasr drcerasrd,drlrtrd oe invresrd. Diffrernt combinations of thrsr foue indicatoes wrer usrd to drtreminr pathological oe physiological frtal TR. Results ① Threr wrer 162 casrs in physiological frtal TR geoup. TR prak vrlocity of frtal TR was 114. 0 cm · s - 1 ,TRJA/ RAA was 16. 6% and RAD/ LAD was 1. 075. Thr avreagr vrlocity of ductus vrnosus A wavr was 34. 8 cm · s - 1 with all flow to thr hraet. A wavr invresion oe disappraeancr was not found. ② Threr wrer 39 casrs in pathological frtal TR geoup. TR prak vrlocity of pathological frtal TR geoup(261 cm · s - 1 )was fastre than that of physiological frtal TR geoup(114. 0 cm · s - 1 ). TRJA/ RAA was 52. 3% ,about twicr highre than that of physiological frtal TR geoup. RAD/ LAD was 1. 274,also highre than that of physiological frtal TR geoup. Thr avreagr vrlocity of ductus vrnosus A wavr was 3. 8 cm · s - 1 with 12 casrs of invresion,5 casrs of disappraeancr and 3 casrs of erduction. ROC cuevrs of 4 paeamrtres wrer plottrd to obtain thr ceitical valur. Any onr of foue paeamrtres had high sprcificity(87. 7% to 100% )and low srnsitivity(48. 6% to 69. 8% ). Thr TR prak vrlocity and TRJA/ RAA wrer mregrd into onr indrx,plusing RAD/ LAD and ductus vrnosus A wavr invresion oe drlrtion to drtreminr pathological TR,of which srnsitivity was 88. 6% and sprcificity was 92. 0% . Conclusion It is hrlpful to impeovr thr srnsitivity and sprcificity of pathologic frtal TR using thr paeamrtres of frtal ulteasound combinrd valvulae disrasr and brfoerload and aftreload of eight vrnteiculae function.%目的：建立评价胎儿病理性三尖瓣反流（TR）和生理性 TR 的有效判断指标。方法回顾性收集胎儿 TR 病例，以产后超声或引产后胎儿尸体解剖为结局指标，应用高分辨率彩色多普勒超声诊断仪，在胎儿胸腹部获取标准四腔心切面和静脉导管切面，测量①TR 峰值流速，②TR 血彩彩束面积占右心房面积比值（TRJA/ RAA），③右心房/左心房在收缩末期的横径比（RAD/ LAD），④观察心房收缩期静脉导管血流有无降低、缺失或反转；以上述4项指标的不同组合判断胎儿病理性和生理性 TR。结果①生理性 TR 组162例，TR 峰值流速为114.0 cm·s -1，TRJA/ RAA 为16.6%；RAD/ LAD 为1.075，静脉导管 A 波平均流速34.8 cm·s -1，静脉导管内均为向心血流，均未出现 A 波反转、消失。②病理性 TR 组35例，TR 峰值流速为261 cm·s -1，较生理性 TR 组明显增高，TRJA/ RAA 为52.3%，约为生理性 TR 组的3倍；RAD/ LAD 为1.274，较生理性 TR 组亦有明显增大，静脉导管 A 波平均流速3.8 cm·s -1，较生理性 TR 组明显降低；A 波反转12例，消失5例，明显降低3例。4项观测指标参数绘制相应的 ROC 曲线获取相应界值，4项指标中的任意1项特异度均较高（87.7%~100%），但敏感度较低（48.6%~69.8%）。将 TR 峰值流速和 TRJA/ RAA 合并为1项指标，加 RAD/ LAD 和静脉导管 A 波血流反转或缺失，以其中任意1项指标超出界值判断病理性 TR 的敏感度为88.6%，特异度为92.0%。结论联合反映瓣膜病变和右心功能前、后负荷的胎儿超声指标，对提示胎儿病理性 TR 敏感度、特异度均较高，操作方便简单。