二维斑点追踪成像技术对超重及肥胖女性孕中晚期胎儿心室构型变化的评估

目的应用二维斑点追踪成像（2D-STI）评价孕前超重及肥胖女性孕中晚期胎儿心室构型变化。 方法回顾性选取2019年6月至2020年3月于空军军医大学唐都医院进行胎儿超声心动图检查的孕妇80例，根据孕前体质量指数（BMI）将其分为正常对照组30例、超重组27例和肥胖组23例。应用胎儿超声心动图获得常规胎儿心脏形态学指标，采用2D-STI技术并利用Fetal HQ软件获得孕24周及孕32周胎儿双侧心室24节段舒张末期横径及球形指数（SI），3组间进行单因素方差分析，并采用LSD-t检验进一步行组间两两比较。 结果常规方法测量肥胖组、超重组与正常对照组孕妇胎儿的左、右心室舒张末期横径，左、右心室舒张末期长径，心胸面积比及左心室每搏输出量，3组间差异均无统计学意义（P均＞0.05）。孕中期（孕24周）肥胖组室间隔厚度较正常对照组增厚［（2.10±0.41）mm vs（1.85±0.33）mm］，孕晚期（孕32周）肥胖组室间隔厚度较正常对照组及超重组均增厚［（3.10±0.65）mm vs（2.46±0.52）mm、（2.55±0.53）mm］，差异均有统计学意义（P均＜0.05）。2D-STI测得肥胖组左心室横径孕24周第6~12节段及孕32周第7~12节段分别较同孕龄正常对照组明显增宽，肥胖组左心室SI孕32周第4~12节段较正常对照组明显降低（P均＜0.05）。2D-STI测得肥胖组右心室横径孕24周第3~10节段及孕32周第1~8节段分别较同孕龄正常对照组明显增宽，肥胖组右心室SI孕32周第1~9节段较正常对照组明显降低（P均＜0.05）。 结论孕前肥胖的孕妇胎儿左心室中间段、右心室基底段节段性横径增宽，与正常对照者相比更接近球形，提示测量左心室中间段及右心室基底段横径可更敏感地反映孕前肥胖孕妇胎儿心室形态的改变。

Evaluation of fetal ventricular morphology in pre-gestational overweight and obese women in the second and third trimester of pregnancy by two-dimensional speckle tracking imaging

ObjectiveTo evaluate fetal ventricular morphology in pre-gestational overweight and obese women in the second and third trimester of pregnancy by two-dimensional speckle tracking imaging (2D-STI). MethodsEighty women with singleton pregnancy at Tangdu Hospital of Air Force Military Medical University from June 2019 to March 2020 were selected retrospectively. According to the pre-pregnancy body mass index (BMI), they were divided into a normal control group (n=30), an overweight group (n=27), and an obese group (n=23). All pregnant women underwent regular and two-dimensional speckle tracking (2D-STI) fetal echocardiography at 24 and 32 weeks of gestation. The 24-segment transverse diameters and spherical indexes (SI) of the left and right ventricle were measured by 2D-STI, and the routine fetal cardiac morphological indexes were obtained by regular fetal echocardiography. All data were compared using one-way ANOVA based on group. Post hoc analyses were performed between groups using LSD-t test. ResultsThere was no significant difference in left and right ventricular end-diastolic transverse diameters, left and right ventricular end-diastolic transverse length, cardiothoracic area ratio, and left ventricular stroke volume between any two of the groups by regular fetal echocardiography (P＞0.05). The interventricular septum diameter in the obese group in the second trimester was thicker than that in the normal control group [(2.10±0.41) mm vs (1.85±0.33) mm, P＜0.05], and that in the obese group in the late pregnancy was thicker than that in the control group and overweight group [(3.10±0.65) mm vs (2.46±0.52) mm and (2.55±0.53) mm, P＜0.05]. The segments 6-12 left ventricle transverse diameters measured by 2D-STI in the obese group at 24 weeks of gestation and the segments 7-12 values at 32 weeks of gestation were significantly wider than those in the control group at the same gestational age. The segments 4-12 left ventricular SI measured by 2D-STI in the obese group at 32 weeks of gestation was significantly lower than that in the control group (P＜0.05). The segments 3-10 right ventricle transverse diameter measured by 2D-STI in the obese group at 24 weeks of gestation and the segments 1-8 values at 32 weeks of gestation were significantly wider than those in the control group at the same gestational age, respectively. The segments 1-9 right ventricular SI measured by 2D-STI in the obese group at 32 weeks of gestation was significantly lower than that in the control group (P＜0.05). ConclusionPre-pregnancy obesity can lead to wider transverse diameter and closer to the sphere in the middle segments of left ventricle and basal segments of right ventricle. It is suggested that the transverse diameters of left ventricular middle segments and right ventricular basal segments can more sensitively reflect the effect of pre-pregnancy obesity on fetal ventricular morphology.