摘要
目的探讨彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义。资料和方法联合应用四腔心和左、右室流出道切面对孕20～24周的5317例非高危胎儿进行心脏扫查,并选择同期697例高危胎儿作为对照组,对所有胎儿均随访至明确诊断。比较非高危胎儿组与高危胎儿组的心脏畸形发生率;应用诊断试验真实性方法对其进行评价,计算出四腔心和左、右室流出道切面筛查胎儿心脏畸形的敏感性、特异性、阳性预测值、阴性预测值以及胎儿心脏畸形的检出率和诊断准确率。结果本研究中胎儿心脏畸形41例,产前超声筛查出38例(非高危胎儿组32例,高危胎儿组6例),分娩后超声证实非高危胎儿组中产前漏诊单纯性室间隔缺损2例、法洛四联症1例,高危胎儿组中右室双出口误诊为法洛四联症1例。本研究心脏畸形的总发生率为6.8‰,非高危胎儿组和高危胎儿组的心脏畸形发生率分别为6.5‰和8.6‰,两组差异无统计学意义(P>0.05);四腔心和左、右室流出道切面筛查胎儿心脏畸形的敏感性、特异性、阳性预测值、阴性预测值分别为90.2%、99.9%、97.3%、99.9%;产前超声心脏畸形检出率和诊断准确率分别为92.6%和90.2%。结论产前超声心脏筛查对非高危胎儿有着重要的临床价值;四腔心和左、右室流出道切面的联合应用在胎儿心脏畸形筛查中有很高的敏感性和特异性,可在各基层医院逐步推广。
Purpose To explore the clinical significance of color Doppler ultrasound in prenatal heart screening in non-high-risk fetus. Materials and Methods A total of 6014 fetuses were included, 5317 in non-high-risk group and 697 in high-risk group. The fetal heart was scanned in four-chamber, left and right ventricular outflow tract views. All fetuses were followed to confirm the diagnosis. The incidences of cardiac anomalies in the two groups were compared. Diagnostic test method was used to calculate the sensitivity, specificity, positive and negative predictive value, prenatal detection rate and diagnostic accuracy of ultrasound to screen cardiac anomalies. Results 41 cardiac anomalies cases were included, of which 38 cases were detected by prenatal ultrasound（32 in non-high-risk group and 6 in high-risk group respectively）. Echocardiography after delivery confirmed that 2 cases of ventricular septal defect and 1 case of tetralogy of Fallot were missed in non-high-risk group; 1 double outlet was misdiagnosed as tetralogy of Fallot prenatally in high-risk group. The incidence of cardiac anomalies in all fetuses, non-high-risk group, high-risk group were 6.8‰, 6.5‰, 8.6‰ respectively. There was no statistical difference in the incidence of cardiac anomalies between the two groups（P0.05）. The sensitivity, specificity, positive predictive value, negative predictive value of untrasound to screen cardiac anomalies were 90.2%, 99.9%, 97.3% and 99.9% respectively. Prenatal detection rate and diagnostic accuracy were 92.6%, 90.2% respectively. Conclusion It is important to perform prenatal ultrasound heart screening in non-high-risk group. The four-chamber, left and right ventricular outflow tract views have high specificity and sensitivity in fetal heart anomalies. It should be gradually introduced into clinical routine.
出处
《中国医学影像学杂志》
CSCD
北大核心
2011年第6期461-464,共4页
Chinese Journal of Medical Imaging
关键词
超声检查
产前
超声检查
多普勒
彩色
心脏缺损
先天性
妊娠
高危
Ultrasonography
prenatal
Ultrasonography
Doppler
color
Heart defects
congenital
Pregnancy
high-risk
