三维超声检测先天性心脏病胎儿的产尿率

目的尝试建立国人胎儿产尿率(UPR)的正常值,并以此评估先天性心脏病(CHD)胎儿的UPR改变情况。方法选择连续检测的49胎CHD胎儿作为病例组,将其分为左心梗阻性病变组、右心梗阻性病变组和混合心脏畸形组;根据胎儿CHD有无合并充血性心力衰竭(CHF)再分为合并CHF组和未合并CHF组。选取同期正常21～40孕(GA)周单胎妊娠胎儿314胎作为正常对照组。采用三维超声体积自动测量(VOCAL)技术测量各组胎儿UPR并进行比较。结果①胎儿UPR随GA增大而增加(r2=0.92,P<0.05),相关方程为:ln(UPR)=-4.7480+(0.3975×GA)+(-0.0044×GA2);②胎儿UPR的改变与胎儿有无CHD及其CHD类型无关(P>0.05);③胎儿UPR与胎儿CHD的心脏功能有关,CHD胎儿合并CHF时UPR下降(P<0.01)。结论 UPR可能是判断胎儿心力衰竭的一项有价值的指标。

Measurement of fetal urine production rate with three-dimensional ultrasonography in fetuses with congenital heart disease

Objective To establish the normal range for fetal urine production rate(UPR) in Chinese population,and to evaluate the change of UPR of fetuses with congenital heart disease(CHD).Methods Totally 49 consecutive fetuses with CHD were selected as the group of CHD and divided into left-sided obstructive lesions,right-sided obstructive lesions and mixed type of CHD.Then CHDs were further divided into two types: CHD complicating congenital heart failure(CHF) and CHD without CHF.A total of 314 fetuses with normal singleton pregnancy at 21 to 40 weeks’ gestation were selected as the control group.Fetal’s UPR was measured with 3D ultrasound using virtual organ computer-aided analysis(VOCAL),and results were compared in groups.Results ①Fetal UPR increased with gestation age(GA).Significant correlation was detected between fetal UPR and GA (r2=0.92,P<0.05).The regression formula was: ln(UPR)=-4.7480+(0.3975×GA)+(-0.0044×GA2).②Fetal UPR was not associated with CHD and its types(P>0.05).③Heart function had important impact on fetal UPR.Fetal UPR decreased when CHD complicated with CHF(P<0.01).Conclusion UPR may be a valuable indicator to evaluate fetal CHF.