CAJ | 학술논문

目的：探讨正常胎儿与主动脉狭窄(AS)胎儿主动脉内径 Z-评分、主动脉/肺动脉内径比值的差异及 Z-评分在 AS 诊断中的应用价值。方法采用彩色多普勒超声心动图对300例孕龄为16~40周的正常胎儿进行研究,测量收缩末期主动脉瓣环内径(AO)及肺动脉瓣环内径(PA)。以双顶径(BPD)、股骨长径(FL)作为自变量,AO、PA 作为应变量建立最佳模型,并分析标准差(SD)与自变量 BPD 及 FL 的相关性,计算正常胎儿 AO 及 PA 的 Z-评分。对106例孕龄为15~40周的 AS 胎儿进行研究,通过上述回归方程计算 AS 胎儿 AO、PA 的 Z-评分,计算 PA/AO 值,与正常胎儿进行统计学比较。分别根据 AO Z-评分、PA/AO 值及 AO 百分范围同时计算 AS 的诊断准确性。结果两组 AO Z-评分及 PA/AO 值差异有统计学意义(P <0.01),PA Z-评分差异无统计学意义(P >0.05)。AS 组96.2%胎儿的 AO Z-评分<-3,95.3% AS 胎儿 PA/AO 值分布于95%置信区间之外。AO Z-评分对 AS 的诊断准确性最高,阳性预测值为89.5%,阴性预测值为98.6%,灵敏性为96.2%,特异性为96%,约登指数为0.9223。PA/AO 值次之,百分范围的最低。结论胎儿 AO Z-评分位于±3之外与 PA/AO 值增大(>1.4)相结合,在 AS 的诊断中具有重要的临床应用价值,较百分范围更能准确地定量评估 AS 胎儿心脏结构的生长发育。
목적：탐토정상태인여주동맥협착(AS)태인주동맥내경 Z-평분、주동맥/폐동맥내경비치적차이급 Z-평분재 AS 진단중적응용개치。방법채용채색다보륵초성심동도대300례잉령위16~40주적정상태인진행연구,측량수축말기주동맥판배내경(AO)급폐동맥판배내경(PA)。이쌍정경(BPD)、고골장경(FL)작위자변량,AO、PA 작위응변량건립최가모형,병분석표준차(SD)여자변량 BPD 급 FL 적상관성,계산정상태인 AO 급 PA 적 Z-평분。대106례잉령위15~40주적 AS 태인진행연구,통과상술회귀방정계산 AS 태인 AO、PA 적 Z-평분,계산 PA/AO 치,여정상태인진행통계학비교。분별근거 AO Z-평분、PA/AO 치급 AO 백분범위동시계산 AS 적진단준학성。결과량조 AO Z-평분급 PA/AO 치차이유통계학의의(P <0.01),PA Z-평분차이무통계학의의(P >0.05)。AS 조96.2%태인적 AO Z-평분<-3,95.3% AS 태인 PA/AO 치분포우95%치신구간지외。AO Z-평분대 AS 적진단준학성최고,양성예측치위89.5%,음성예측치위98.6%,령민성위96.2%,특이성위96%,약등지수위0.9223。PA/AO 치차지,백분범위적최저。결론태인 AO Z-평분위우±3지외여 PA/AO 치증대(>1.4)상결합,재 AS 적진단중구유중요적림상응용개치,교백분범위경능준학지정량평고 AS 태인심장결구적생장발육。
Objective To explore the difference in Z-score reference range for aorta measurements, and pulmonary artery(PA)/aortic(AO)valve annular diameter ratio(PA/AO ratio)between normal and aortic stenosis(AS)fetuses and to evaluate the diagnostic value of Z-score of aorta in fetuses with AS. Methods A retrospective cross-sectional study of fetal color Doppler echocardiograms were undertook from 300 singleton normal fetuses with gestational age ranged from 16 to 40 weeks.Standardized fetal echocardiographic measurements included AO valve annular diameter and PA valve annular diameter at end-systole,and PA/AO ratio were obtained.With statistical analysis,best model was established for predicting AO and PA using biparietal diameter (BPD)and femoral length (FL)as independent variables.The correlations between standard deviation (SD)and two independent variables (BPD,FL)were analyzed,and the AO Z-score and PA Z-score of normal fetuses were calculated.One hundred and six singleton fetuses with AS were studied whose gestational age ranged from 1 5 to 40 weeks.The AO Z-score and PA Z-score of AS fetuses obtained by using above regression equation and PA/AO ratio were subsequently calculated.The AO and PA Z-scores and PA/AO ratio between normal fetuses and AS fetuses were compared.And the detection rate of AS according to AO Z-score,PA/AO ratio and AO percentile range were assessed.Results Compared with normal fetuses,the Z-score of AO and the PA/AO ratio in AS fetuses were statistically different (P <0.01).While there was no statistical difference of Z-score of PA between two groups (P >0.05).AO Z-score in 96.2% of AS fetuses were found < -3,PA/AO ratio in 95.3% of AS fetuses were found outside 95% CI.The method using AO Z-score had the highest detection rate of AS,the positive predictive value was up to 89.5%,the negative predictive value was up to 98.6%,the sensitivity,specificity and Youden index were 96.2%,96%,and 0.9223,respectively.PA/AO ratio had good but slightly lower diagnostic accuracy than AO Z-score,while AO percentile range performed poor.Conclusions Fetuses whose AO Z-score are outside ±3 and the PA/AO ratio is greater than 1 .4 at the same time are more likely to suffured from AS.Quantification of AO Z-score has important clinical value in the diagnosis of AS,and is more accurate than the percentile range in quantitative assessment of congenital heart growth and development of the fetal pathology of AS.