摘要
目的探讨超声心动检查联合孕妇血清微小RNA-19b(miRNA-19b)、甲胎蛋白(Alpha-fetoprotein,AFP)测定对胎儿先天性心脏病诊断的临床价值,以提高疾病的阳性检出率。方法选取2016年1月~2019年4月我院行产检的2352例孕妇为研究对象,136例失访,根据生产结局,将孕妇分成异常组(n=26)和正常组(n=2190)。于妊娠15~21w对其胎儿行超声心动检查,t检验比较血清miRNA-19b和AFP水平,应用受试者工作特征(Receiver operating characteristic,ROC)曲线评估单一指标及联合诊断胎儿先天性心脏病的诊断效能。结果在受检孕妇中,超声心动图检查诊断先天性心脏病胎儿716例,法洛四联症125例,室间隔缺损268例,完全性房间隔缺损131例,心房异构86例,永存动脉干106例;异常组患者血清AFP和miRNA-19b水平明显高于正常组(P<0.05);超声心动图诊断胎儿先天性心脏病对应的灵敏度为76.92%、特异度为68.22%、约登指数为0.451、ROC曲线下面积为0.807(95%CI 0.751~0.863);血清miRNA-19b诊断胎儿先天性心脏病临界值为4.55,对应灵敏度为65.38%、特异度为69.82%、约登指数为0.352、ROC曲线下面积为0.737(95%CI 0.673~0.801);血清AFP诊断胎儿先天性心脏病临界值为32.6ug/L,对应的灵敏度为61.53%、特异度为61.55%、约登指数为0.230、ROC曲线下面积为0.651(95%CI 0.578~0.725);三者联合诊断胎儿先天性心脏病灵敏度为88.46%、特异度为60.96%、约登指数为0.494、ROC曲线下面积为0.879(95%CI 0.835~0.923),联合诊断的灵敏度和约登指数高于超声心动检查联合孕妇血清miRNA-19b、AFP单独检测。结论超声心动检查联合孕妇血清miRNA-19b、AFP测定可有效提高冠心病诊断的各项性能指标,其中孕妇血清miRNA-19b、AFP是对超声心动检查很好的补充,对胎儿先天性心脏病早期诊断具有重要价值。
Objective:To investigate the value of echocardiography combined with serum miRNA-19b and AFP in the diagnosis of fetal congenital heart disease.Methods:2352 pregnant women who had prenatal examination in our hospital from January 2016 to April 2019 were enrolled in this study,136 pregnant women were lost and divided into abnormal group(n=26)and normal group(n=2190)according to the outcome of delivery.The fetuses were examined by echocardiography at 15-21 weeks of gestation.The levels of serum miRNA-19b and AFP were compared by t-test.The diagnostic efficacy of single index and combined diagnosis of fetal congenital heart disease was evaluated by receiver operating characteristic curve of working characteristics of the subjects.Results:Among the pregnant women examined,716 fetuses with congenital heart disease,125 with tetralogy of Fallot,268 with ventricular septal defect,131 with complete atrial septal defect,86 with atrial heterogeneity and 106 with persistent truncus arteriosus were diagnosed by echocardiography.The levels of serum AFP and miRNA-19b in the abnormal group were significantly higher than those in the normal group.The sensitivity,specificity and AUC of fetal congenital heart disease were 76.92%,68.22%,0.451 and 0.807(95%CI 0.751-0.863)respectively;the critical value of serum mirna-19b was 4.55 and 65.38%,69.82%,0.352 and 0.737(95%CI 0.673-0.80)respectively;the critical value of serum AFP in the diagnosis of fetal congenital heart disease was 32.6μg/L,the corresponding sensitivity was 61.53%,the specificity was 61.55%,the Jordan index was 0.230,and the AUC was 0.651(95%CI 0.578-0.725).The combined sensitivity of the three combined diagnosis of fetal congenital heart disease was 88.46%,the specificity was 60.96%,the Yoden index was 0.494,and the AUC was 0.879(95%CI 0.835-0.923).The sensitivity and Jordan index of combined diagnosis were higher than those of echocardiography combined with serum miRNA-19b and AFP detection in pregnant women.Conclusion:Echocardiography combined with the determination
作者
杨伟
王峥
YANG Wei;WANG Zheng(Functional Department of the Second Outpatient Department of Hebei Province,Shijiazhuang 050011;Ultrasound Department of Xiyuan District,the first Central Hospital of Baoding City,Hebei Province,071000)
出处
《中国优生与遗传杂志》
2020年第5期618-621,共4页
Chinese Journal of Birth Health & Heredity
