摘要
Abstract
Objective To evaluate the value of fetal echocardiography for the prenatal diagnosis of congenital heart disease. Methods A search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periedieal Database and Chinese Bio-medicine Database ( CBM ) was performed to identify relevant English and Chinese language articles from Jan 1990 to Jan 2009. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed by employing Meta-Dise 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUG) was calculated. Finally, sensitivity analysis waa performed. Results Eighteen articles were included, with a total of 77 939 fetuses. Seven articles meeting with inclusion criteria were analyzed for the value of basic cardiac echocardiographic examination (BCEE) for the prenatal diagnosis of congenital heart disease. The pooled sensitivity and specificity were 41.7% and 99. 9% respectively, AUC =0. 978 7. Twelve articles meeting with inclusion criteria were analyzed for the value of extended cardiac echocardiographie examination (ECEE). The pooled sensitivity and specificity were 66. 9% and 99. 9% respectively, AUG = 0. 995 6. The sensitivity of ECEE was significantly higher than that of BCEE (x<'2> = 63. 93, P < 0. 05). The random-effect model was used in the analysis because of the heterogeneity. The layering research and sensitivity analysis were performed on the BCEE and ECEE. The sensitivity of BCEE and ECEE for the prenatal diagnosis of congenital heart disease during the second to third trimester was significantly higher than that during the second trimester (x<'2> = 5.47,39. 37, P < 0. 05 ) ; The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of low-risk pregnant women was lower than that of the unselected or high-risk pregnant women (x<'2> = 81.82,156. 58, P < 0. 05 ) ; The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of unselected pregnant women was not different from that of high-risk pregnant women(x<'2> = 1.67 ,P > 0. 05 ). Conclusions The results suggested that fetal echocardingraphy was highly accurate and suitable for the prenatal diagnosis of congenital heart disease. Further multieentre and prospective studies are still needed to optimize the ultrasound section and screening subjects by a cost-effectiveness analysis, and develop an operation guideline on fetal echocardiography for the prenatal diagnosis of congenital heart disease suitable for China.关键词
心脏缺损,先天性/超声心动描记术/超声检查,产前/Meta分析Key words
Heart defects,congenital/Echocardiography/Ultrasonography,prenatal/Meta-analysis分类
医药卫生
