胎儿超声心动图检查定量11~17周正常胎儿主动脉和肺动脉内径Z-评分的初步研究

目的探讨早孕期（11^＋0周~13^＋6周）和中孕早期（14^＋0周~17^＋6周）胎儿主动脉内径（AO）与肺动脉内径（PA）与胎儿生物学生长参数的相关性，初步建立早孕期和中孕早期胎儿AO与PA的正常参考值范围及Z-评分方程，并评价方程的有效性。 方法随机选取孕周（GA）为（11^＋0周~17^＋6周）正常单胎胎儿270例，将成功显示左、右心室流出道切面的245例胎儿纳入研究，获得胎儿顶臀径（CRL）、双顶径（BPD）、股骨长径（FL）、孕周（GA）等生物学生长参数。在胎儿左、右心室流出道切面测量收缩末期AO及PA，以GA、BPD和FL作为独立自变量，AO及PA作为因变量，建立AO、PA的正常参考值范围，并对每个参数的绝对残差（SD）进行加权回归，建立Z-评分方程。 结果采用简单的线性回归模型，可以很好地描述AO和PA与非心脏生物特征参数（BPD、FL、GA）的关系。AO、PA与GA、BPD、FL均呈显著线性相关（GA与AO：r=0.9276，GA与PA：r=0.9271，BPD与AO：r=0.9551，BPD与PA：r=0.9558，FL与AO：r=0.9462，FL与PA：r=0.9483，均<0.001），其中与BPD的相关性最强。 结论正常早孕期及中孕早期胎儿的AO、PA随着孕周的增加而增长，本研究初步建立了正常胎儿早孕期及中孕早期AO、PA的参考范围及其Z-评分方程。为早孕期及中孕早期评估胎儿大血管生长提供精确的参考标准，在早期筛查或诊断胎儿先天性心脏畸形方面具有潜在的应用价值。

Quantification of Z-scores of normal fetal aortic and pulmonary diameters using fetal echocardiography at 11~17 weeks of gestation

Objective To determine the reference ranges and Z-score equations for aortic and pulmonary diameters in normal fetuses based on the measurements of biparietal diameter(BPD),femur length(FL),or gestational age(GA)using fetal echocardiography at 11~17 weeks of gestation.Methods A total of 245 singleton normal fetuses were enrolled at 11~17 weeks of gestation.Non-cardiac fetal biometric parameters including BPD,FL,and GA were recorded.Fetal cardiac measurements of aortic(AO)and pulmonary valve annulus diameters(PA)at end-systole were performed.The normal reference ranges and Z-score equations of AO and PA at 11~17 weeks of gestation were established.Using GA,BPD,and FL as independent variables,and AO and PA as dependent variables,Z-score equations of normal fetal AO and PA were established.Results The relationship of AO and PA with non-cardiac biological characteristic parameters(GA,BPD,and FL)can be well described by using a simple linear regression model.AO and PA had a significant linear correlation with GA,BPD,and FL;among them,the correlation with BPD was the most significant.Conclusion The AO and PA of normal fetuses at 11~17 weeks of gestation increase with gestational age.The normal reference ranges and Z-score equations of AO and PA at 11~17 weeks of gestation have been preliminarily established,thus providing accurate reference criteria for the early assessment of fetal cardiovascular growth by fetal echocardiography,which has potential value in early screening of fetal congenital cardiac malformation.