摘要
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CHD245例（87．18％）、复杂型CHD36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CHD36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CHD7例，敏感性2．9％；复杂型CHD29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。
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. 820/00 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.
出处
《中华围产医学杂志》
CAS
2011年第12期729-734,共6页
Chinese Journal of Perinatal Medicine
基金
上海交通大学医学院科技基金项目（06XJ21120）
