超声对胎儿主动脉缩窄的诊断价值分析

目的 分析各项超声心动图指标在胎儿主动脉缩窄方面的诊断价值，探讨不同超声参数诊断的敏感度及特异性，进一步综合评估多个超声参数的诊断价值。方法 选取在笔者医院行胎儿超声心动图检查提示可疑主动脉缩窄、主动脉峡部偏细的胎儿62例，以出生后超声心动图检查或尸检证实为金标准，分为缩窄组与正常组。对两组的超声参数进行统计学分析，包括右心室/左心室横径（RV/LV）、主肺动脉/升主动脉内径（PA/AO）、主动脉峡部/动脉导管内径（AI/DA）、主动脉峡部/升主动脉内径（AI/AO）、主动脉峡部Z分数（AI Z-score）、升主动脉Z分数（AO Z-score）。结果 AI/DA、PA/AO、AI Z-score、AO Z-score、AI/AO指标ROC曲线下面积（AUC）>0.5，有一定的诊断价值（P<0.05）。当以PA/AO>1.78、AI/DA<0.56、AI Z-score<-2、AO Z-score<-2、AI/AO<0.57为截断值，诊断胎儿主动脉缩窄的敏感度分别为63.6%、90.9%、90.9%、63.6%、72.7%，特异性分别为80.0%、77.5%、65.0%、67.5%、57.5%。单一指标诊断的价值有限，2~3个任意指标超过界值时，其超声联合诊断价值提高。结论 以AI/DA<0.56为截断值，推荐作为诊断胎儿主动脉缩窄的一项超声指标。单一超声指标诊断胎儿主动脉缩窄的诊断价值有限，联合多个超声指标诊断及综合评估心脏大血管情况可提高该病诊断的敏感度与特异性。

Clinical Value of Ultrasonography in Diagnosis of Fetal Aorta Coarctation

Objective To compare and analyze the diagnostic value of various ultrasonic parameters in the diagnosis of fetal aorta coarctation, to explore the diagnostic sensitivity and specificity of echocardiography parameters, and the diagnostic value of multiple ultrasonic parameters. Methods Sixty-two cases of fetus checked by fetal echocardiography in our hospital and were suspected fetus aortic coarctation or fetus of narrow aortic. They were confirmed by echocardiography after birth or autopsy as golden standard, divided into narrow group and normal group. The measurements of right ventricle/left ventricle ratio(RV/LV),pulmonary artery/aorta ratio (PA/AO),isthmus/duct ratio (AI/DA),isthmus/aorta ratio (AI/AO),isthmus Z-score (AI Z-score),ascending aorta Z-score (AO Z-score) were analysised. Results The AI/DA,PA/AO,AI Z-score,AO Z-score,AI/AO were calculated. ROC curve showed their area under ROC were>0.5 with a significant statistical significance (P<0.05). PA/AO>1.78,AI/DA<0.56,AI Z-score<-2,AO Z-score<-2,AI/AO<0.57 as the cut-off value, the sensitivity were 63.6%,90.9%,90.9%,63.6%,72.7% respectively; specificity were 80.0%,77.5%,65.0%,67.5%,57.5% respectively.The diagnostic value of single ultrasonic parameter is low. The diagnostic value of multiple ultrasound parameters is improved when the number of the parameters increased to 2 or 3. Conclusion AI/DA<0.56 is recommended by the author to diagnose fetal aorta coarctation. The value of single parameter of fetal echocardiography in diagnosis of fetal aortic coarctation is lower. Combining multiple ultrasound parameters and the comprehensive evaluation of the heart vascular condition can improve the sensitivity and specificity of ultrasound diagnosis.