颈部透明层厚度、心脏三尖瓣反流和静脉导管血流联合Z评分对胎儿先天性心脏病的诊断效能分析

目的研究颈部透明层厚度（NT）、心脏三尖瓣反流（TR）和静脉导管血流（DV）联合胎儿心脏测量参数Z评分对胎儿先天性心脏病的诊断效能。 方法采用2015年1月至2020年2月在内蒙古医学院附属医院进行孕早期新生儿筛查的6 217例孕妇作为研究对象，根据引产与分娩共确证胎儿患有先心病分为观察组和对照组，分别对两组胎儿的NT、TR、DV以及心脏测量参数Z评分进行比较。分析NT、TR、DV与Z评分的联合对胎儿先天性心脏病的诊断效能。 结果观察组胎儿的NT、TR、DV异常率均高于对照组（χ²=1 953.577、1 805.085、1 339.066，均P＜0.001）。在以双顶径的预测中，观察组胎儿的主动脉Z评分低于对照组（0.012±0.001 vs 0.023±0.002，t=84.259，P＜0.001），肺动脉Z评分高于对照组（0.035±0.002 vs 0.025±0.003，t=38.623，P=0.000）；在以股骨长的预测中，观察组胎儿的主动脉Z评分（0.022±0.003 vs 0.037±0.004，t=38.172，P＜0.001）以及肺动脉Z评分（0.031±0.005 vs 0.039±0.003，t=12.474，P＜0.001）低于对照组；在以实际孕周的预测中，观察组胎儿的主动脉Z评分（0.013±0.001 vs 0.022±0.002，t=68.939，P＜0.001）以及肺动脉Z评分（0.014±0.002 vs 0.019±0.003，t=19.312，P＜0.001）低于对照组。NT、TR、DV与Z评分联合诊断胎儿先天性心脏病的灵敏度为93.44%，显著优于单独诊断；NT、TR、DV与Z评分联合诊断胎儿先天性心脏病的受试者工作特征曲线下面积为0.892，显著高于单独检测（95%CI：0.654~0.912，P＜0.001）。 结论NT、TR、DV联合胎儿心脏测量参数Z评分对胎儿先天性心脏病具有积极的诊断意义。

Diagnostic efficacy of nuchal translucency,tricuspid regurgitation,and ductus venosus combined with Z- score in fetal congenital heart disease

ObjectiveTo evaluate the diagnostic efficacy of nuchal translucency (NT), tricuspid regurgitation (TR), and ductus venosus (DV) combined with Z-score in fetal congenital heart disease. MethodsA total of 6217 pregnant women who underwent early-trimester neonatal screening at the Affiliated Hospital of Inner Mongolia Medical College from January 2015 to February 2020 were selected as the research subjects. According to the co-confirmation of labor induction and delivery, the fetuses were divided into either an observation group or a control group. The NT, TR, and DV values and the cardiac measurement parameter Z-score of the fetuses were compared between the two groups. ResultsThe abnormal rates of NT, TR, and DV in the observation group were all higher than those in the control group (χ²=1953.577, 1805.085, and1339.066, respectively, P＜0.001). In the prediction with a double-top diameter, the aortic Z score of the observation group was lower than that in the control group (0.012±0.001 vs 0.023±0.002, t=84.259, P=0.000); the pulmonary artery Z score was higher than that of the control group (0.035±0.002 vs 0.025±0.003, t=38.623, P=0.000). In the prediction by femur length, the Z scores of the aorta and pulmonary artery of the fetus in the observation group were both lower than those in the control group (0.022±0.003 vs 0.037±0.004 and 0.031±0.005 vs 0.039±0.003, t=38.172 and 12.474, respectively, P＜0.001). In the prediction with actual gestational age, the Z score of the aorta and pulmonary artery of the fetus in the observation group were both lower than those in the control group (0.013±0.001 vs 0.022±0.002 and 0.014±0.002 vs 0.019±0.003, t=68.939 and 19.312, respectively, P＜0.001). The diagnostic sensitivity of the combination of NT, TR, and DV values with Z score for fetal congenital heart disease was 93.44%, which was significantly higher than that of any single index alone. The area under the receiver operating characteristic curve (AUC) of the combination of NT, TR, and DV values with Z score in diagnosis of congenital heart disease was 0.892, which was higher than that of any single index alone (95%CI: 0.654~0.912, P＜0.001). ConclusionNT, TR, and DV combined with the fetal heart measurement parameter Z-score has positive diagnostic significance for fetuses with congenital heart disease.