早孕期超声检查胎儿颈项透明层厚度 心率及心轴对胎儿先天性心脏病的预测价值

目的 探讨早孕期超声检查胎儿颈项透明层（NT）厚度、心率及心轴对胎儿先天性心脏病的预测价值。方法 选择2015年7月1日至2017年7月1日就诊于安徽医科大学第二附属医院的168例孕龄12～14周孕妇（均为单胎妊娠），采用彩色多普勒超声测定胎儿NT、心率、心轴，所有孕妇均随访至分娩后1周，统计胎儿发生先天性心脏病的例数，绘制ROC曲线，分析NT厚度、心率及心轴对胎儿先天性心脏病的预测价值。结果 NT预测胎儿先天性心脏病ROC曲线下面积为0.895（P<0.001），NT预测胎儿先天性心脏病最佳截点为2.995 mm，此时灵敏度为0.882，特异度为0.961；心轴预测胎儿先天性心脏病ROC曲线下面积为0.657（P=0.021），心轴预测胎儿先天性心脏病最佳截点为50.891度，此时灵敏度为0.643，特异度为0.598；心率预测胎儿先天性心脏病ROC曲线下面积为0.616（P=0.045），心率预测胎儿先天性心脏病最佳截点为179次/分钟，此时灵敏度为0.556，特异度为0.879。结论 孕早期NT厚度、心率及心轴检查对预测胎儿先天性心脏病及心脏畸形具有一定临床意义，其中NT厚度预测价值最大。

Predictive value of ultrasonography of cervical clear layer thickness heart rate and cardiac axis in fetal congenital heart disease in early pregnancy

Objective To investigate the predictive value of ultrasonography of fetal cervical translucency (NT) thickness, heart rate and axis in congenital heart disease (CHD) in early pregnancy. Methods The clinical data of 168 pregnant women gestationally aged 12 to 14 weeks who were admitted to this hospital from July 1, 2015 to July 1, 2017 were selected. All the pregnant women were single pregnancy. The fetal NT, heart rate and cardiac axis were measured by color Doppler ultrasound. All pregnant women were followed up for one week after delivery, and the number of cases of congenital heart disease in the first week after delivery was counted. The roc curves were plotted. The predictive value of NTR, heart rate and cardiac axis in fetal congenital heart disease was assessed. Results According to NT prediction in fetal congenital heart disease, the area under the ROC curve was 0.895 (P<0.001), the best point of fetal congenital heart disease was 2.995 mm, the sensitivity was 0.882, and the specificity was 0.961. According to arbor prediction in fetal congenital heart disease, the area under the ROC curve was 0.657 (P=0.021), the best point of fetal congenital heart disease was 50.891 degrees, the sensitivity was 0.643, and the specificity was 0.598. In heart rate prediction of fetal congenital heart disease, the area under the ROC curve was 0.616 (P=0.045), the best point of fetal congenital heart disease predicted by heart rate was 179 time/min, the sensitivity was 0.556, and the specificity was 0.879. Conclusion NT thickness, heart rate and cardiac axis ultrasound examinations in early pregnancy have certain clinical significance in predicting fetal congenital heart disease and cardiac malformation, and NT thickness has the most significant predicative value.