胎儿先天性心脏病的高危因素及产前超声筛查的意义
|
摘要
目的研究胎儿先天性心脏病(CHD)的高危因素及产前超声筛查的意义,为优生优育提供理论依据。方法选取2014年1月～2018年1月在我院参加孕期超声体检的1640例单胎妊娠孕妇作为研究对象,对其进行产前超声筛查,比较产前超声筛查结果和尸检、出生后超声系统检查结果,并回顾性分析其临床资料,采用卡方检验和Logistic多因素分析筛选产前胎儿先天性心脏病发病的高危因素。结果 1640例孕妇产前超声诊断为先天性心脏病18例,发生率为1.10%,产后超声心动图证实10例,引产后尸检证实7例,误诊1例,准确率94.44%。单因素和进一步Logicstics回归多因素分析显示,年龄≥35、CHD家族史、妊娠期高血压、孕妇主动或被动吸烟史和孕妇妊娠期糖尿病是CHD发生的独立的危险因素。结论产前超声是筛查胎儿先天性心脏病的有效方法,对具有高危因素的孕妇,应重点筛查早期发现和干预,达到优生优育的目的。
Objective:To study the high risk factors of fetal congenital heart disease(CHD)and the significance of prenatal ultrasound screening,and provide a theoretical basis for prenatal and postnatal care. Methods:A total of 1640 single-pregnant pregnant women who participated in the ultrasound examination in pregnancy from January to May 20,2014 were enrolled in the study. Prenatal ultrasound screening was performed to compare prenatal ultrasound screening results and autopsy,after birth.Ultrasound system examination results,and retrospective analysis of its clinical data,using chi-square test and Logistic multifactor analysis to screen for high risk of prenatal fetal congenital heart disease factor. Results:In 1640 cases,prenatal ultrasound was diagnosed as congenital heart disease in 18 cases,the incidence rate was 1.10%,postpartum echocardiography confirmed 10 cases,postoperative induction of autopsy confirmed 7 cases,misdiagnosis in 1 case,the accuracy rate was 94.44%. Univariate and further Logicstics regression multivariate analysis showed that age≥35,family history of CHD,gestational hypertension,active or passive smoking history in pregnant women,and gestational diabetes in pregnant women were independent risk factors for CHD. Conclusion:Prenatal ultrasound is an effective method for screening fetal congenital heart disease. For pregnant women with high risk factors,early detection and intervention should be screened to achieve the goal of prenatal and postnatal care.
Objective:To study the high risk factors of fetal congenital heart disease(CHD)and the significance of prenatal ultrasound screening,and provide a theoretical basis for prenatal and postnatal care. Methods:A total of 1640 single-pregnant pregnant women who participated in the ultrasound examination in pregnancy from January to May 20,2014 were enrolled in the study. Prenatal ultrasound screening was performed to compare prenatal ultrasound screening results and autopsy,after birth.Ultrasound system examination results,and retrospective analysis of its clinical data,using chi-square test and Logistic multifactor analysis to screen for high risk of prenatal fetal congenital heart disease factor. Results:In 1640 cases,prenatal ultrasound was diagnosed as congenital heart disease in 18 cases,the incidence rate was 1.10%,postpartum echocardiography confirmed 10 cases,postoperative induction of autopsy confirmed 7 cases,misdiagnosis in 1 case,the accuracy rate was 94.44%. Univariate and further Logicstics regression multivariate analysis showed that age≥35,family history of CHD,gestational hypertension,active or passive smoking history in pregnant women,and gestational diabetes in pregnant women were independent risk factors for CHD. Conclusion:Prenatal ultrasound is an effective method for screening fetal congenital heart disease. For pregnant women with high risk factors,early detection and intervention should be screened to achieve the goal of prenatal and postnatal care.
引文
[1]Yu HC,Coughlin CR,Geiger EA,et al.Discovery of a potentially deleterious variant in TMEM87B in a patient with a hemizygous2q13 microdeletion suggests a recessive condition characterized by congenital heart disease and restrictive cardiomyopathy[J].Cold Spring Harb Mol Case Stud,2016,2(3):a000844.
[2]Matsumoto A,Aoyagi Y,Mitomo M,et al.Outcome of fetal echocardiography:a 17 year single-institution experience in Japan[J].Pediatr Int,2012,54(5):634-638.
[3]Olney RS,Ailes EC,Sontag MK.Detection of critical congenital heart defects:Review of contributions from prenatal and newborn screening[J].Semin Perinatol,2015,39(3):230-237.
[4]Leirgul E,Fomina T,Brodwall K,et al.Birth prevalence of congenital heart defects in Norway 1994-2009--a nationwide study[J].Am Heart J,2014,168(6):956-964.
[5]闫景彬,闫秀梅,杨建享,等.产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析[J].中华全科医学,2016,(1):114-115+160.
[6]Caton AR,Bell EM,Druschel CM,et al.Antihypertensive medication use during pregnancy and the risk of cardiovascular malformations[J].Hypertension,2009,54(1):63-70.
[7]马丽.妊娠期高血压与胎儿先天性心脏病发病风险的meta分析[J].临床儿科杂志,2017,(5):372-376.
[8]张欢,张颖.产前超声在胎儿先天性心脏病筛查中的应用及危险因素分析[J].中国妇幼保健,2017,(6):1245-1247.
[9]邹琳.浙江武义地区先天性心脏病患儿影响因素的病例对照研究[J].中国优生与遗传杂志,2015,(1):89-91.
[2]Matsumoto A,Aoyagi Y,Mitomo M,et al.Outcome of fetal echocardiography:a 17 year single-institution experience in Japan[J].Pediatr Int,2012,54(5):634-638.
[3]Olney RS,Ailes EC,Sontag MK.Detection of critical congenital heart defects:Review of contributions from prenatal and newborn screening[J].Semin Perinatol,2015,39(3):230-237.
[4]Leirgul E,Fomina T,Brodwall K,et al.Birth prevalence of congenital heart defects in Norway 1994-2009--a nationwide study[J].Am Heart J,2014,168(6):956-964.
[5]闫景彬,闫秀梅,杨建享,等.产前超声筛查胎儿先天性心脏病的临床意义及高危因素分析[J].中华全科医学,2016,(1):114-115+160.
[6]Caton AR,Bell EM,Druschel CM,et al.Antihypertensive medication use during pregnancy and the risk of cardiovascular malformations[J].Hypertension,2009,54(1):63-70.
[7]马丽.妊娠期高血压与胎儿先天性心脏病发病风险的meta分析[J].临床儿科杂志,2017,(5):372-376.
[8]张欢,张颖.产前超声在胎儿先天性心脏病筛查中的应用及危险因素分析[J].中国妇幼保健,2017,(6):1245-1247.
[9]邹琳.浙江武义地区先天性心脏病患儿影响因素的病例对照研究[J].中国优生与遗传杂志,2015,(1):89-91.