四维超声心动图在胎儿先天性心脏病筛查及诊断中的应用价值
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摘要
目的探讨四维超声心动图在胎儿先天性心脏病筛查及诊断中的应用价值。方法选取广州市越秀区妇幼保健院2015年10月至2017年3月应用四维超声心动图及二维彩色多普勒超声对心脏情况进行检查的胎儿384例,以引产病理解剖及随访结果为参照,比较二维彩色多普勒超声与四维超声心动图对不同类型心脏结构异常诊断的敏感度、特异度、准确度等。结果 384例胎儿中69例未完成研究,根据引产病理解剖及分娩后的追踪随访结果,剩余315例胎儿中心脏正常251例,心脏异常64例,胎儿心脏畸形比例为20.4%,二维彩色多普勒超声及四维超声心动图诊断率分别为38.1%和31.7%,两者比较差异无统计学意义(χ2=1.322,P=0.295)。二维彩色多普勒超声的阳性预测值为51.00%,阴性预测值为93.95%;四维超声心动图的阳性预测值为84.51%,阴性预测值为98.36%。四维超声心动图的敏感度、特异度、准确度分别为93.8%(95%CI 89.4%~96.7%)、95.6%(95%CI 88.2%~97.7%)、95.2%(95%CI 87.1%~97.3%),二维彩色多普勒超声敏感度、特异度、准确度分别为79.7%(95%CI74.3%~85.2%)、80.5%(95%CI 75.5%~85.7%)、80.3%(95%CI 76.6%~86.8%),两种方法敏感度(χ2=7.76,P=0.009)、特异度(χ2=24.18,P<0.001)及准确度(χ2=31.66,P<0.001)比较差异均有统计学意义。结论四维超声心动图可提高先天性心脏畸形筛查的准确度、敏感度及特异度。
Objective To explore the application value of four-dimensional ultrasound for screening and diagnosis of fetal congenital heart disease. Methods A total of 384 fetal hearts examinationwere enrolled f rom Oct. 2015 to Mar. 2017 in our hospital and all fetal hearts were examined with fourdimensional ultrasound and two-dimensional color Doppler ultrasonography. Results of pathological studies after abortion or postpartum follow-up data served as diagnostic reference. The sensitivity, specifi city and accuracy were compared between the two methods. Results There were 69 cases withdrown f rom the study. According to the results of postpartum follow-up or pathology results after abortion, there were 251 normal and 64 abnormal fetal hearts. The rate of fetal heart malformation was 20.4%. The diagnostic rate of four-dimensional ultrasound and two-dimensional color Doppler ultrasonography were 31.7% and 38.1% respectively. There were no signifi cant differences between the two methods(χ2=1.322, P=0.295). The positive predictive value of two-dimensional color Doppler ultrasonography was 51.00%, and the negative predictive value was 93.95%. While the positive predictive value of four-dimensional ultrasound was 84.51%, and the negative predictive value was 98.36%. The sensitivity, specifi city and accuracy of four-dimensional ultrasound were 93.8%(95%CI 89.4%-96.7%), 95.6%(95%CI 88.2%-97.7%), 95.2%(95%CI 87.1%-97.3%) respectively and the sensitivity, specifi city and accuracy of the two-dimensional color Doppler ultrasonography were 79.7%(95%CI 74.3%-85.2%), 80.5%(95%CI 75.5%-85.7%), 80.3%(95%CI 76.6%-86.8%)respectively, suggesting there was statistical difference between the 2 methods(P <0.05). Conclusions Four-dimensional ultrasound can effectively improve the sensitivity, specifi city and accuracy for screening and diagnosis of congenital heart defects.
Objective To explore the application value of four-dimensional ultrasound for screening and diagnosis of fetal congenital heart disease. Methods A total of 384 fetal hearts examinationwere enrolled f rom Oct. 2015 to Mar. 2017 in our hospital and all fetal hearts were examined with fourdimensional ultrasound and two-dimensional color Doppler ultrasonography. Results of pathological studies after abortion or postpartum follow-up data served as diagnostic reference. The sensitivity, specifi city and accuracy were compared between the two methods. Results There were 69 cases withdrown f rom the study. According to the results of postpartum follow-up or pathology results after abortion, there were 251 normal and 64 abnormal fetal hearts. The rate of fetal heart malformation was 20.4%. The diagnostic rate of four-dimensional ultrasound and two-dimensional color Doppler ultrasonography were 31.7% and 38.1% respectively. There were no signifi cant differences between the two methods(χ2=1.322, P=0.295). The positive predictive value of two-dimensional color Doppler ultrasonography was 51.00%, and the negative predictive value was 93.95%. While the positive predictive value of four-dimensional ultrasound was 84.51%, and the negative predictive value was 98.36%. The sensitivity, specifi city and accuracy of four-dimensional ultrasound were 93.8%(95%CI 89.4%-96.7%), 95.6%(95%CI 88.2%-97.7%), 95.2%(95%CI 87.1%-97.3%) respectively and the sensitivity, specifi city and accuracy of the two-dimensional color Doppler ultrasonography were 79.7%(95%CI 74.3%-85.2%), 80.5%(95%CI 75.5%-85.7%), 80.3%(95%CI 76.6%-86.8%)respectively, suggesting there was statistical difference between the 2 methods(P <0.05). Conclusions Four-dimensional ultrasound can effectively improve the sensitivity, specifi city and accuracy for screening and diagnosis of congenital heart defects.
引文
[1]李德义,罗莉,熊萍,等.二维超声三切面法筛查胎儿先天性心脏畸形的可行性及局限性探讨.中国医药导刊,2013,15(4):601-605.
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[3]尹立雪.胎儿超声心动图检查规范-美国超声心动图学会指南解读.实用医院临床杂志,2012,9(5):1-2.
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[6]顾莉莉,李胜利,文华轩,等.胎儿实时三维(四维)超声心动图的初步临床应用.中华医学超声医学杂志,2011,8(1):9-13.
[7]胡高杰,冯天鹰,哈斯,等,胎儿先天性心脏病超声心动图的临床应用进展.生物医学工程与临床,2012,16(3):304-308.
[8]Zeng S,Zhou J,Peng Q,et al.Assessment by three-dimensional power doppler ultrasound of cerebral blood fl ow perfusion in fetuses with congenital heart disease.Ultrasound Obstet Gynecol,2015,45(6):649-656.
[9]Koning IV,Graafeiland AW,Groenenberg IAL,et al.Prenatal infl uence of congenital heart defects on trajectories of cortical folding of the fetal brain using three-dimensional ultrasound.Prenat Diaqn,2017,37(10):1008-1016.
[10]Simpson JM.Three-dimensional echocardiography in congenital heart disease:The next steps.Arch Cardiovasc Dis,2016,46(1):81-83.
[11]张彤,石伟元,张晓红.彩色多普勒超声诊断胎儿心脏畸形的临床分析.南华大学学报(医学版),2010,38(1):138-139.
[12]李婷,蔡爱露.空间-时间相关成像技术在胎儿心脏脏畸形诊断中的应用.中国临床医学影像杂志,2012,23(6):401-403.
[13]钱晓芹,杨斌.时间-空间相关成像(STIC)技术的各种成像模式在胎儿心脏检查中的应用.中国产前诊断杂志(电子版),2011,3(1):31-34.
[2]胡波,胡兵.四维超声在胎儿心脏畸形诊断中的应用.中华妇幼临床医学杂志(电子版),20l 2,8(2):208-210.
[3]尹立雪.胎儿超声心动图检查规范-美国超声心动图学会指南解读.实用医院临床杂志,2012,9(5):1-2.
[4]吕国荣.胎儿颅脑和心脏畸形超声诊断.北京:北京大学医学出版社,2010:199-200.
[5]李治安.重视胎儿超声心动图检查的适应证和安全性.中华医学超声杂志(电子版),2012,9(9):758-759.
[6]顾莉莉,李胜利,文华轩,等.胎儿实时三维(四维)超声心动图的初步临床应用.中华医学超声医学杂志,2011,8(1):9-13.
[7]胡高杰,冯天鹰,哈斯,等,胎儿先天性心脏病超声心动图的临床应用进展.生物医学工程与临床,2012,16(3):304-308.
[8]Zeng S,Zhou J,Peng Q,et al.Assessment by three-dimensional power doppler ultrasound of cerebral blood fl ow perfusion in fetuses with congenital heart disease.Ultrasound Obstet Gynecol,2015,45(6):649-656.
[9]Koning IV,Graafeiland AW,Groenenberg IAL,et al.Prenatal infl uence of congenital heart defects on trajectories of cortical folding of the fetal brain using three-dimensional ultrasound.Prenat Diaqn,2017,37(10):1008-1016.
[10]Simpson JM.Three-dimensional echocardiography in congenital heart disease:The next steps.Arch Cardiovasc Dis,2016,46(1):81-83.
[11]张彤,石伟元,张晓红.彩色多普勒超声诊断胎儿心脏畸形的临床分析.南华大学学报(医学版),2010,38(1):138-139.
[12]李婷,蔡爱露.空间-时间相关成像技术在胎儿心脏脏畸形诊断中的应用.中国临床医学影像杂志,2012,23(6):401-403.
[13]钱晓芹,杨斌.时间-空间相关成像(STIC)技术的各种成像模式在胎儿心脏检查中的应用.中国产前诊断杂志(电子版),2011,3(1):31-34.