中孕胎儿卵圆孔面积大小及血流动力学对婴幼儿心脏房缺的预判价值

摘要

目的 探讨中孕胎儿卵圆孔面积大小及血流动力学指标对婴幼儿心脏房缺的预判价值.方法 选取2015年1月至2015年12月在东莞市大朗医院行胎儿超声心动图检查的2000例孕妇,孕周20～28周,分别于产前及产后随访超声检查.结果 共有1231例(61.55％)产妇获得完整随访资料,其中产后胎儿诊断继发孔房间隔缺损(ASD)共40例,发生率为3.25％;产后继发孔ASD胎儿产前卵圆孔面积为(0.48±0.12)cm2,明显高于产后心脏正常胎儿(P<0.05),而峰值血流速度为(0.37±0.13)m/s,明显低于产后心脏正常胎儿(P<0.05);产后继发孔ASD胎儿和产后心脏正常胎儿,产前肺动脉、动脉导管最大血流速度、三尖瓣E峰、A峰比较差异无统计学意义(P>0.05);产前卵圆孔面积和峰值血流速度诊断继发孔ASD的ROC曲线下面积分别为0.891和0.762,P<0.05,以产前卵圆孔面积≥0.31 cm2标准,诊断继发孔ASD灵敏度和特异性分别为97.50％和93.20％,以产前峰值血流速度≤0.43 cm2标准,诊断继发孔ASD灵敏度和特异性分别为79.70％和85.00％.结论 中孕胎儿卵圆孔面积和峰值血流速度在诊断ASD中有一定的参考价值.%Objective To investigate the predictive value of the size of foramen ovale area and hemodynamic parameters of middle pregnancy fetus in prenatal diagnosis for infants with atrial septal defect. Methods A total of 2000 pregnant women with fetal echocardiography and gestational age ranged from 20 to 28 weeks, who admitted to our hospital from January 2015 to December 2015, were selected as the research objects. Prenatal and postnatal fol-low-up were examined by ultrasonography. Results The complete follow-up was performed in 1231 pregnant women (61.55％), and 40 fetuses were diagnosed as secondary atrial septal defect (ASD) by prenatal diagnosis with the inci-dence rate of 3.25％. The prenatal foramen ovale area of fetuses with secondary ASD was (0.48±0.12) cm2, which was significantly higher than that of fetuses with normal heart (P<0.05), while the peak blood flow velocity was (0.37 ± 0.13) m/s, which was significantly lower than that of fetuses with normal heart (P<0.05). Between fetuses with postpar-tum secondary ASD and those with postpartum normal heart, there was no significant difference in the maximum bloodflow velocity of the pulmonary artery and ductus arteriosus, tricuspid valve E peak value and A peak valve (P>0.05). The area under the ROC curve for the diagnosis of secondary ASD of prenatal foramen ovale area and peak blood flow veloc-ity were 0.891 and 0.762, respectively (P<0.05). Taking prenatal foramen ovale area≥0.31 cm2 as the standard, the sen-sitivity and specificity of the diagnosis of secondary ASD were respectively 97.50％ and 93.20％; the sensitivity and specificity of the diagnosis of secondary ASD were 79.70％ and 85.00％ based on the standard of prenatal peak blood flow velocity≤0.43 cm2. Conclusion The foramen ovale area and peak blood flow velocity of middle pregnancy have some reference value in the diagnosis of ASD, which is worthy of further study.