遇建东

[摘要] 目的 探讨产前四维超声在胎儿先天性心脏畸形（CHD）中的应用价值。 方法 收集2016年4月～2019年5月在我院进行胎儿超声心动图筛查的胎儿CHD高危孕妇680例为观察对象，均接受产前四维超声检查，以引产病理/随访结果作为金标准，评估产前四维超声对胎儿CHD的检出率及诊断价值。 结果 680例高危因素孕妇经引产病理/随访结果证实为CHD者67例，发病率为9.85%;产前四维超声检出的胎儿CHD 64例，检出率为95.52%，二者比较差异无统计学意义（χ2=3.069，P=0.080）;产前四维超声对胎儿CHD诊断的阳性预测值为98.44%，阴性预测值为99.35%，灵敏度为94.03%，特异度为99.84%，准确率为99.26%;产前四维超声对胎儿CHD诊断的ROC曲线下面积为0.841（95%CI：0.790～0.892）。 结论 产前四维超声在胎儿先天性心脏畸形中具有较高的检出率，且诊断灵敏度、特异度、准确率均较高，值得推广。

[关键词] 产前检查;四维超声;先天性心脏畸形;检出率

[中图分类号] R445.1          [文献标识码] B          [文章编号] 1673-9701（2020）35-0104-04

[Abstract] Objective To explore the application value of prenatal four-dimensional ultrasound in fetal congenital heart defects（CHD）. Methods A total of 680 pregnant women with high risk of fetal CHD who underwent fetal echocardiography screening in our hospital from April 2016 to May 2019 were collected as observation objects. All of them underwent prenatal four-dimensional ultrasound examination. Using pathological/follow-up results of induction of labor as the gold standard， the detection rate and diagnostic value of prenatal four-dimensional ultrasound for fetal CHD was assessed. Results Sixty-seven cases of 680 pregnant women with high risk factors were confirmed to be CHD by pathological/follow-up results of induction of labor， and the incidence rate was 9.85%. Sixty-four cases of fetal CHD were detected by prenatal four-dimensional ultrasound， and the detection rate was 95.52%， and the difference between the above two was not significant（χ2=3.069， P=0.080）. The positive predictive value， the negative predictive value， the sensitivity， the specificity， and the accuracy of prenatal four-dimensional ultrasound for the diagnosis of fetal CHD was 98.44%， 99.35%， 94.03%， 99.84%， and 99.26 %. The area under the ROC curve of prenatal four-dimensional ultrasound in the diagnosis of fetal CHD was 0.841（95% CI： 0.790～0.892）. Conclusion Prenatal four-dimensional ultrasound has a high detection rate in fetal congenital heart malformations， and the diagnostic sensitivity， specificity， and accuracy are high， which is worthy of promotion.

[Key words] Prenatal examination; Four-dimensional ultrasound; Congenital heart malformations; Detection rate

胎兒先天性心脏畸形（Congenital heart disease， CHD）为常见的出生缺陷，是胚胎发育时期即出现的心脏结构、功能、心血管形态的异常，数据显示，其在活产儿中的发病率达5‰～10‰，而存在高危因素的孕妇其胎儿发生CHD的风险达10%以上[1-2]。CHD胎儿在娩出后夭折或者早期死亡率较高，且家庭需承受经济、精神双重打击，故而临床上越来越重视产前筛查工作[3]。产前胎儿超声为一种简便、无辐射、无创的检查手段，尤其是四维超声的应用，能够清晰显示胎儿的心脏结构与功能，对于早期发现胎儿心脏结构的异常、减少出生婴儿死亡率、提高出生人口质量意义重大[4]。……