摘要
Abstract
Objective:Ultrasound markers such as the thickness of fetal nuchal translucency(NT),ductus venosus A-wave direction(DVa)and tricuspid valve flow regurgitation(TR)during the first trimester were analyzed to explore their clinical application value for screening high-risk infants with congenital heart disease(CHD).
Methods:A retrospective analysis of NT,DVa and TR ultrasonic markers data of fetuses of pregnant women who underwent regular prenatal examination and ultrasound examination at 11-13 weeks'gestation from June 2022 to December 2023 in Shanghai Changning District Maternal and Child Health Care Hospital was conducted,combined with fetal echocardiography and follow-up of pregnancy outcomes.The relationship between abnormal ultrasound markers and CHD pregnancy outcomes was analyzed.The binary logistic regression analysis and the receiver-operating characteristic(ROC)curve were used for ROC curve analysis of joint indicators and the comparison of the ROC curve of each single indicator.The efficacy of different abnormal ultrasound markers and their combinations in screening CHD was evaluated.
Results:Among the 1 868 fetuses during the first trimester,there were 62 cases of increased NT thickness,55 cases of abnormal DVa,and 22 cases of TR,among which 8 cases of both abnormal NT and DVa markers,6 cases of both abnormal NT and TR markers,and 3 cases of both abnormal DVa and TR markers.There was 1 case with increased NT thickness,DVa abnormality and TR abnormality at the same time,and the remaining 1 716 fetuses did not have any of the abnormal ultrasound markers mentioned above.The detection rate of CHD in any of the three ultrasonic markers(increased NT thickness or DVa abnormality or TR)was significantly higher than that in the normal ultrasound markers(x2=465.27,43.35 and 54.43,respectively,and the P-value was all less than 0.001).When a single marker was abnormal,increased NT thickness had the highest efficacy in screening CHD with 0.789 of the maximum area under ROC curve[AUC,95％CI(0.701,0.876),P＜0.001].As for the combined markers for screening CHD,the diagnostic efficiency of simultaneously abnormal NT and DVa[AUC=0.812,95％CI(0.604,1.000),P=0.002)]as well as simultaneously abnormal NT and TR[AUC=0.7 85,95％CI(0.555,1.000),P=0.009)]was better than that of simultaneously abnormal DVa and TR(AUC=0.52 1)as well as simultaneously abnormal NT,DVa and TR(AUC=0.571).And the screening efficiency of simultaneously abnormal NT and DVa was significantly higher than that of any single indicator(P＜0.001).
Conclusions:The use of ultrasound markers including NT,DVa and TR during the first trimester can effectively screen CHD high-risk fetuses,and the combined application of NT and DVa has certain clinical application value with higher screening efficiency.关键词
超声标记/心脏畸形/颈项透明层厚度/静脉导管频谱/三尖瓣反流Key words
Ultrasound marker/Cardiac malformation/Nuchal translucency thickness/Venous catheter spectrum/Tricuspid regurgitation分类
医药卫生
