CAJ | 학술논문

目的评价二维超声四切面法,即四腔心切面、左室流出道切面、右室流出道切面和三血管平面在胎儿先天性心脏病(congenital heart disease,CHD)筛查中的价值. 方法应用二维超声四切面法对孕21～25周的2419例胎儿进行CHD筛查,并对所有2382例活产新生儿行超声心动图检查.统计学分析采用x2检验,并计算敏感性、特异性、阳性预测值和阴性预测值. 结果 2419例胎儿中产前筛查出CHD共281例(11.62％),其中简单型CHD 245例(87.18％)、复杂型CHD 36例(12.82％).高危因素组和非高危因素组阳性率分别为13.60％(34/250)和11.39％(247/2169),差异无统计学意义(x2=1.069,P=0.301).产前四切面法筛查阳性且新生儿期超声心动图检查诊断CHD 36例,总体敏感性、特异性、阳性预测值、阴性预测值分别为12.8％、99.8％、90.0％和89.7％；诊断简单型CHD 7例,敏感性2.9％；复杂型CHD 29例,敏感性80.6％.产后新生儿诊断CHD252例,占活产新生儿总数的10.58％(252/2382),其中简单型241例,复杂型11例. 结论二维超声产前四切面法对简单型CHD诊断敏感性较低,对复杂型CHD诊断的敏感性较高.在常规产前超声检查中加入心脏四切面法可筛查出大部分的胎儿复杂型CHD,而简单型CHD漏诊率仍较高,新生儿超声心动图普查可弥补产前CHD筛查的不足.
목적 평개이유초성사절면법,즉사강심절면、좌실류출도절면、우실류출도절면화삼혈관평면재태인선천성심장병(congenital heart disease,CHD)사사중적개치. 방법 응용이유초성사절면법대잉21～25주적2419례태인진행CHD사사,병대소유2382례활산신생인행초성심동도검사.통계학분석채용x2검험,병계산민감성、특이성、양성예측치화음성예측치. 결과 2419례태인중산전사사출CHD공281례(11.62％),기중간단형CHD 245례(87.18％)、복잡형CHD 36례(12.82％).고위인소조화비고위인소조양성솔분별위13.60％(34/250)화11.39％(247/2169),차이무통계학의의(x2=1.069,P=0.301).산전사절면법사사양성차신생인기초성심동도검사진단CHD 36례,총체민감성、특이성、양성예측치、음성예측치분별위12.8％、99.8％、90.0％화89.7％；진단간단형CHD 7례,민감성2.9％；복잡형CHD 29례,민감성80.6％.산후신생인진단CHD252례,점활산신생인총수적10.58％(252/2382),기중간단형241례,복잡형11례. 결론 이유초성산전사절면법대간단형CHD진단민감성교저,대복잡형CHD진단적민감성교고.재상규산전초성검사중가입심장사절면법가사사출대부분적태인복잡형CHD,이간단형CHD루진솔잉교고,신생인초성심동도보사가미보산전CHD사사적불족.
Objective To investigate the value of combined four-chamber view,left and right ventricular outflow tract view and three-vessel view of two-dimensional echocardiography (2DE) in prenatal screening for fetal congenital heart disease (CHD). Methods Four combined views of 2DE were used to detect fetal hearts in 2419 fetuses at 21～ 25 gestational weeks.The echocardiograms were performed on all 2382 live-birth infants.Chi-square test was applied for statistical analysis.Sensitivity,specificity,positive predict value and negative predict value were calculated. Results The prevalence of fetal CHD was 11.62％ (281/2419).Among the 281 CHD fetuses,87.18％ were simple CHD (n=245) and 12.82％ were complex CHD (n=36).No difference was found in the positive rate of fetal CHD between the high-risk group and non-high-risk group [13.60％(34/250) vs 11.39％(247/2169),x2=1.069,P＜0.05].Thirty-six cases of CHD could be detected by the four combined views in prenatal screening with the sensitivity,specificity,positive and negative predictive value of 12.8％,99.8％,90.0％ and 89.7％,respectively.However,the diagnostic sensitivity of four combined views for simple CHD was 2.9％(7/245) and 80.6％(29/36) for complex CHD.The prevalence of neonatal CHD was 10.58％ (252/2382),including 241 with simple CHD and 11 complex ones. Conclusions Four combined views of 2DE for prenatal screening is less sensitive in detecting simple CHD than complex CHD.Most of the complex CHD could be diagnosed by four combined views of 2DE before birth,but the misdiagnosis rate is high in simple CHD.The echocardiograms performed on newborns might make up for the lack.