孕早期UVC血流频谱参数联合孕中期四维彩超诊断心脏发育畸形的研究

doi:10.7517/issn.1674-0475.220707

摘要/Abstract

摘要： 本文探讨孕早期脐静脉导管(UVC)彩色多普勒超声血流频谱参数联合孕中期四维彩超诊断胎儿先天性心脏发育畸形的临床价值。选取62例先天性心脏发育畸形胎儿作为观察组,同期180例分娩且心脏正常发育的胎儿作为对照组,两组均于孕11～13周接受UVC彩色多普勒超声检查,孕17～27周接受四维彩超检查。结果显示,观察组胎儿UVC彩色多普勒超声血流频谱参数心房收缩期峰值速度(A)、心室舒张期峰值速度(D)、心室收缩期速度(S)、A波最大速度(Tamax)测定值均低于对照组(P<0.05);观察组胎儿UVC彩色多普勒超声血流频谱参数搏动指数(PI)、静脉前负荷指数(PLI)、静脉峰值流速指数(PVIV)测定值均高于对照组(P<0.05);孕早期S、D、A、Tamax、PI、PLI、PVIV测定值诊断胎儿心脏发育畸形的AUC值分别为0.702、0.849、0.647、0.768、0.826、0.757、0.676;孕中期四维彩超诊断胎儿心脏发育畸形的整体符合率为93.55%;四维彩超诊断心脏发育畸形的灵敏度为93.55%、特异度为98.33%。孕早期UVC彩色多普勒超声血流频谱参数与孕中期四维彩超筛查对筛查胎儿先天性心脏发育畸形有较好的效果。

关键词: 孕早期, 脐静脉导管, 彩色多普勒超声, 血流频谱, 四维彩超, 先天性心脏病

Abstract: This paper explored the clinical value of umbilical venous catheter (UVC) color Doppler ultrasound blood flow spectrum parameters in the first trimester combined with four-dimensional color Doppler ultrasound in the second trimester in the diagnosis of fetal congenital cardiac developmental malformations. A total of 62 fetuses with congenital cardiac developmental malformations were selected as the observation group, and 180 fetuses with normal heart development during the same period were selected as the control group. Both groups received UVC color Doppler ultrasound examination at 11 to 13 weeks of gestation, and four-dimensional color Doppler ultrasound examination at 17 to 27 weeks of gestation. The results showed that the measured values of fetal UVC color Doppler ultrasound blood flow spectrum parameters atrial systolic peak velocity (A), ventricular diastolic peak velocity (D), ventricular systolic velocity (S) and A wave maximum velocity (Tamax) in the observation group were lower than those in the control group (P<0.05). The measured values of fetal UVC color Doppler ultrasound blood flow spectrum parameters pulsatility index (PI), venous preload index (PLI) and venous peak velocity index (PVIV) in the observation group were higher than those in the control group (P<0.05). The AUC values of S, D, A, Tamax, PI, PLI and PVIV in the first trimester were 0.702, 0.849, 0.647, 0.768, 0.826, 0.757 and 0.676, respectively. The overall coincidence rate of four-dimensional color Doppler ultrasound in the diagnosis of fetal cardiac malformation in the second trimester was 93.55%. The sensitivity and specificity of four-dimensional color Doppler ultrasound in the diagnosis of cardiac developmental malformations were 93.55% and 98.33%. The application of UVC color Doppler ultrasound blood flow spectrum parameters in the first trimester combined with the four-dimensional color ultrasound screening in the second trimester has a better effect on the detection of fetal congenital cardiac malformations and measures.

Key words: early pregnancy, umbilical vein catheter, color Doppler ultrasound, blood flow spectrum, four-dimensional color ultrasound, congenital heart disease

刘海宁, 赵国栋, 齐海英. 孕早期UVC血流频谱参数联合孕中期四维彩超诊断心脏发育畸形的研究[J]. 影像科学与光化学, 2022, 40(6): 1359-1363.

LIU Haining, ZHAO Guodong, QI Haiying. Study of UVC Blood Flow Spectrum Parameters in the First Trimester Combined with Four-dimensional Color Doppler Ultrasound in the Second Trimester in the Diagnosis of Cardiac Developmental Malformations[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(6): 1359-1363.

参考文献

[1] Burns J, Varughese R, Ganigara M, et al. Neurodevelopmental outcomes in congenital heart disease through the lens of single ventricle patients[J]. Current Opinion in Pediatrics, 2021, 33(5):535-542.
[2] Cao L, Du Y, Zhang M, et al. High maternal blood lipid levels during early pregnancy are associated with increased risk of congenital heart disease in offspring[J]. Acta Obstetricia et Gynecologica Scandinavica, 2021, 100(10):1806-1813.
[3] Westaby J D, Cooper S T E, Edwards K A, et al. Insights from examination of hearts from adults dying suddenly to the understanding of congenital cardiac malformations[J]. Clinical Anatomy, 2020, 33(3):394-404.
[4] Krishnan R, Deal L, Chisholm C, et al. Concordance between obstetric anatomic ultrasound and fetal echocardiography in detecting congenital heart disease in high-risk pregnancies[J]. Journal of Ultrasound in Medicine, 2021, 40(10):2105-2112.
[5] 王玉波,高艳多,贺勇,等.胎儿心脏畸形孕早期筛查中脐静脉导管血流频谱参数与染色体异常的关系分析[J].中国优生与遗传杂志, 2020, 28(1):83-85, 91.
[6] 刘志宝,李光,李静,等.孕早期胎儿脐静脉导管彩色多普勒超声血流频谱参数结合血清蛋白测定在先天性心脏畸形中的诊断价值及与胎儿染色体异常关系[J].中国医刊, 2022, 57(4):456-461.
[7] 裘品丹,袁晓丹,谢旭敏. 11~13~(+6)周胎儿静脉导管血流频谱异常在胎儿染色体异常和心脏畸形评估中的作用[J].现代医用影像学, 2018, 27(2):364-367.
[8] 焦敬,赵金惠.探讨孕中期不同时段超声检查对胎儿心脏畸形的诊断价值及对胎儿心脏畸形检出率的影响[J].中国优生与遗传杂志, 2020, 28(5):628-630.
[9] 罗丽芳,吴惠双,杜燕飞,等.静脉导管多普勒血流频谱筛查对孕早期胎儿先天性心脏病的临床意义[J].现代医用影像学, 2020, 29(4):623-625.
[10] 许彬,寇燕妮.孕早期超声检测颈部透明层增厚与静脉导管频谱异常在筛查胎儿复杂先天性心脏畸形中的价值[J].中国优生与遗传杂志, 2020, 28(12):1507-1510.
[11] 周海红.孕中期不同时段超声检查对胎儿心脏畸形的诊断价值[J].中国优生与遗传杂志, 2019, 27(1):66-68, 2.
[12] 李宜,毛晓惠.四维超声成像技术诊断孕中期胎儿心脏畸形的价值探讨[J].山西医药杂志, 2020, 49(16):2111-2113.
[13] 赵艳春,吕国荣,李敏,等.四维超声STIC技术检测中孕早期胎儿心脏畸形[J].中国医学影像技术, 2013, 29(2):260-263.
[14] 戴青里,刘燕,骆志玲.二维联合四维超声诊断产前胎儿心脏畸形的临床研究[J].昆明医科大学学报, 2015, 36(5):65-68.
[15] Rizk J. 4D flow MRI applications in congenital heart disease[J]. European Radiology, 2021, 31(2):1160-1174.
[16] 谢维维,解左平,邱合荣.中孕早期观察胎儿静脉导管血流频谱a谷形态筛查胎儿心脏畸形的意义[J].中国优生与遗传杂志, 2017, 25(4):106-107.
[17] 张伟娟,张蕊,陈文敏,等.孕早期胎儿颈项透明层厚度联合孕中期四维超声在体表畸形筛查中的诊断价值[J].现代医用影像学, 2021, 30(8):1567-1570.
[18] 刘凤林,许占英,李建荣.胎儿颈项透明层厚度超声与孕中期四维彩色多普勒超声联合诊断胎儿畸形的价值分析[J].中国药物与临床, 2019, 19(10):1617-1618.
[19] 黄正妹.孕11~13周⁺⁶NT超声检查联合孕中期四维彩超筛查胎儿畸形的价值[J].现代诊断与治疗, 2021, 32(23):3809-3810.