Tei指数评估先天性心脏病胎儿左心室功能的应用价值
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摘要
目的探讨Tei指数评估先天性心脏病(CHD)胎儿左心室功能的应用价值。方法收集2017年6月～2018年10月于我院经胎儿超声心动图诊断为CHD胎儿44例作为病例组,根据心胸面积比值大小分为心胸比正常(n=29)和心胸比增大(n=15);另选取同期同孕龄正常妊娠胎儿60例作为正常对照组。利用M型超声心动图和脉冲多普勒观察所有胎儿左室短轴缩短率(LVFS)、左室射血分数(LVEF),二尖瓣口E/A值及左心室的Tei指数(LVTei)。结果病例组胎儿LVEF低于正常对照组胎儿,LVTei高于正常对照组胎儿,差异有统计学意义(P<0.05);两组胎儿LVFS、E/A比较,差异无统计学意义(P>0.05)。病例组中心胸比正常胎儿LVTei高于正常对照组,差异有统计学意义(P<0.05);病例组中心胸比正常胎儿与正常对照组LVEF、LVFS及E/A比较,差异无统计学意义(P>0.05)。病例组中心胸比增大胎儿LVTei高于心胸比正常及正常对照组胎儿,LVEF、LVFS及E/A低于心胸比正常及正常对照组胎儿,差异有统计学意义(P<0.05)。结论 Tei指数测量方法简单,可重复性强,可作为评估CHD胎儿左心功能的指标,为早期评估患儿预后提供可靠依据,并指导患儿围产期的治疗。
Objective To investigate the application value of Tei index in evaluating left ventricular function in congenital heart disease(CHD).Methods From June 2017 to October 2018, 44 cases of CHD fetus were diagnosed as fetal cases by fetal echocardiography. According to the ratio of cardiothoracic area, the cardiothoracic ratio was normal(n=29) and the ratio of cardiothoracic ratio was increased(n=15); 60 cases of normal pregnancy with the same gestational age were selected as the normal control group. All fetal left ventricular short axis shortening rate(LVFS), left ventricular ejection fraction(LVEF), mitral valve E/A value, and left ventricular Tei index(LVTei) were observed using M-mode echocardiography and pulsed Doppler.Results The fetal LVEF in the case group was lower than that in the normal control group, and the LVTei was higher than that in the normal control group,the difference was statistically significant(P<0.05). There was no significant difference in the LVFS and E/A between the two groups(P>0.05). In the case group, the central chest was higher than the normal fetus LVTei than the normal control group,the difference was statistically significant(P<0.05). There was no significant difference between the normal group and the normal control group LVEF, LVFS and E/A( P>0.05). In the case group, the chest height ratio of the fetus was higher than that of the normal and normal control group. The LVEF, LVFS and E/A were lower than those of the normal and normal control group,the difference was statistically significant( P<0.05).Conclusion The Tei index measurement method is simple and reproducible. It can be used as an index to evaluate the left ventricular function of CHD, provide a reliable basis for early assessment of the prognosis of children, and guide the treatment of perinatal period.
Objective To investigate the application value of Tei index in evaluating left ventricular function in congenital heart disease(CHD).Methods From June 2017 to October 2018, 44 cases of CHD fetus were diagnosed as fetal cases by fetal echocardiography. According to the ratio of cardiothoracic area, the cardiothoracic ratio was normal(n=29) and the ratio of cardiothoracic ratio was increased(n=15); 60 cases of normal pregnancy with the same gestational age were selected as the normal control group. All fetal left ventricular short axis shortening rate(LVFS), left ventricular ejection fraction(LVEF), mitral valve E/A value, and left ventricular Tei index(LVTei) were observed using M-mode echocardiography and pulsed Doppler.Results The fetal LVEF in the case group was lower than that in the normal control group, and the LVTei was higher than that in the normal control group,the difference was statistically significant(P<0.05). There was no significant difference in the LVFS and E/A between the two groups(P>0.05). In the case group, the central chest was higher than the normal fetus LVTei than the normal control group,the difference was statistically significant(P<0.05). There was no significant difference between the normal group and the normal control group LVEF, LVFS and E/A( P>0.05). In the case group, the chest height ratio of the fetus was higher than that of the normal and normal control group. The LVEF, LVFS and E/A were lower than those of the normal and normal control group,the difference was statistically significant( P<0.05).Conclusion The Tei index measurement method is simple and reproducible. It can be used as an index to evaluate the left ventricular function of CHD, provide a reliable basis for early assessment of the prognosis of children, and guide the treatment of perinatal period.
引文
[1]黄建玲,卢伊玲,刘良华,等.产前超声检查对胎儿先天性心脏病诊断的临床价值[J].现代医用影像学,2015,24(2):273-275.
[2]张兴,王慧深,方群.选择性宫内生长受限胎儿心功能超声评价[J].中华实用儿科临床杂志,2015(13):996-999.
[3]Hernandez-Andrade E,Patwardhan M,Cruz-Lemini M,et al.Early Evaluation of the Fetal Heart[J].Fetal Diagn Ther,2017,42(3):161-173.
[4]Huhta JC.Diagnosis and treatment of foetal heart failure:foetal echocardiography and foetal hydrops[J].Cardiol Young,2015,25(S2):100-106.
[5]Thakur V,Fouron JC,Mertens L,et al.Diagnosis and Management of Fetal Heart Failure[J].Canadian Journal of Cardiology,2013,29(7):759-767.
[6]Khalil A,Rodgers M,Baschat A,et al.ISUOG Practice Guidelines:role of ultrasound in twin pregnancy[J].Ultrasound in Obstetrics&Gynecology,2016,47(2):247-263.
[7]Lakshminrusimha S,Saugstad OD.The fetal circulation,pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates,and the role of oxygen therapy[J].Journal of Perinatology,2016(36):S3-S11.
[8]Chawengsettakul S,Russameecharoen K,Wanitpongpan P.Fetal cardiac function measured by myocardial performance index of small-for-gestational age fetuses[J].Journal of Obstetrics&Gynaecology Research,2015,41(2):222-228.
[9]Gapp-Born E,Sananes N,Weingertner AS,et al.Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome[J].Prenat Diagn,2014,34(9):908-914.
[10]田海燕,张小杉,胡燕华,等.Tei指数在评价妊娠期高血压孕妇胎儿心功能中的作用[J].中国超声医学杂志,2018(1):56-58.
[11]Natarajan S,Szwast A,Tian Z,et al.Right ventricular mechanics in the fetus with hypoplastic left heart syndrome[J].Journal of the American Society of Echocardiography,2013,26(5):515-520.
[12]Mary T,Donofrio,Anita J,et al.Diagnosis and treatment of fetal cardiac disease:a scientific statement from the American Heart Association[J].Circulation,2014,129(21):2183-242.
[13]Bhorat IE,Bagratee JS,Pillay M,et al.Determination of the myocardial performance index in deteriorating grades of intrauterine growth restriction and its link to adverse outcomes[J].Prenatal Diagnosis,2015,35(3):266-273.
[2]张兴,王慧深,方群.选择性宫内生长受限胎儿心功能超声评价[J].中华实用儿科临床杂志,2015(13):996-999.
[3]Hernandez-Andrade E,Patwardhan M,Cruz-Lemini M,et al.Early Evaluation of the Fetal Heart[J].Fetal Diagn Ther,2017,42(3):161-173.
[4]Huhta JC.Diagnosis and treatment of foetal heart failure:foetal echocardiography and foetal hydrops[J].Cardiol Young,2015,25(S2):100-106.
[5]Thakur V,Fouron JC,Mertens L,et al.Diagnosis and Management of Fetal Heart Failure[J].Canadian Journal of Cardiology,2013,29(7):759-767.
[6]Khalil A,Rodgers M,Baschat A,et al.ISUOG Practice Guidelines:role of ultrasound in twin pregnancy[J].Ultrasound in Obstetrics&Gynecology,2016,47(2):247-263.
[7]Lakshminrusimha S,Saugstad OD.The fetal circulation,pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates,and the role of oxygen therapy[J].Journal of Perinatology,2016(36):S3-S11.
[8]Chawengsettakul S,Russameecharoen K,Wanitpongpan P.Fetal cardiac function measured by myocardial performance index of small-for-gestational age fetuses[J].Journal of Obstetrics&Gynaecology Research,2015,41(2):222-228.
[9]Gapp-Born E,Sananes N,Weingertner AS,et al.Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome[J].Prenat Diagn,2014,34(9):908-914.
[10]田海燕,张小杉,胡燕华,等.Tei指数在评价妊娠期高血压孕妇胎儿心功能中的作用[J].中国超声医学杂志,2018(1):56-58.
[11]Natarajan S,Szwast A,Tian Z,et al.Right ventricular mechanics in the fetus with hypoplastic left heart syndrome[J].Journal of the American Society of Echocardiography,2013,26(5):515-520.
[12]Mary T,Donofrio,Anita J,et al.Diagnosis and treatment of fetal cardiac disease:a scientific statement from the American Heart Association[J].Circulation,2014,129(21):2183-242.
[13]Bhorat IE,Bagratee JS,Pillay M,et al.Determination of the myocardial performance index in deteriorating grades of intrauterine growth restriction and its link to adverse outcomes[J].Prenatal Diagnosis,2015,35(3):266-273.