临床误诊误治2025，Vol.38Issue(20)：14-22,9.DOI:10.3969/j.issn.1002-3429.2025.20.003
频谱多普勒超声特征对胎儿肺静脉异位引流的诊断价值及漏诊影响因素分析
Diagnostic value of spectral Doppler ultrasonographic features on fetal total anomalous pulmonary venous drainage and the influencing factors of missed diagnosis
摘要
Abstract
Objective To analyze the diagnostic value of spectral Doppler ultrasonographic features on fetal total anomalous pulmonary venous drainage(TAPVD)and the influencing factors of missed diagnosis.Methods A retrospective analysis was conducted on the clinical data of 5,000 pregnant women who underwent prenatal testing from January 2021 to December 2024.According to whether the pregnant women underwent spectral Doppler ultrasound(SDUS)examination before delivery,they were divided into the SDUS examination group(n=2,164)and the non-SDUS examination group(n=2,836).Among 5,000 pregnant women,44 cases of fetal TAPVD were screened out.Among them,7 cases of missed diagnosis were included in the missed diagnosis group,and 37 cases of no missed diagnosis were included in the non-missed diagnosis group.The general information of pregnant women and the rate of missed diagnosis were compared.The diagnostic value of spectral Doppler ultrasonographic features for fetal TAPVD was analyzed by using the receiver operating characteristic(ROC)curve.Multivariate Logistic regression analysis was used to analyze the influencing factors of missed diagnosis of fetal TAPVD in pregnant women before delivery.The latent class analysis method was adopted to compare the differences in the distribution characteristics of influencing factors between the high-risk missed diagnosis group and the low-risk missed diagnosis group.Results There was a significant difference in the rate of missed diagnosis between the SDUS examination group and the non-SDUS examination group(P<0.05).ROC curve analysis showed that the area under the curve of spectral Doppler ultrasonographic features for fetal TAPVD was 0.791(95%CI:0.725,0.856),and the sensitivity and specificity were 82.33%and 76.19%,respectively.The results of multivariate Logistic regression analysis showed that,abnormal amniotic fluid volume,abnormal left atrial size,combined with other cardiac structural abnormalities,limited experience of doctors,pulmonary vein blood flow velocity of ectopic drainage<47.15 cm/s,and failure to perform SDUS examination were all independent risk factors affecting the missed diagnosis of fetal TAPVD in pregnant women before delivery(P<0.05).The results of latent class analysis showed that the proportion of"distribution with multiple risk factors"in the high-risk group was 68.75%(11/16),which was significantly higher than 32.14%(9/28)in the low-risk group,showing significant difference(P<0.05).The proportion of"distribution with few risk factors"in the high-risk group was 31.25%(5/16),which was significantly lower than 67.86%(19/28)in the low-risk group,showing significant difference(P<0.05).Conclusion Spectral Doppler ultrasonographic features have certain predictive value for the classification of fetal TAPVD.Abnormal amniotic fluid volume,abnormal size of the left atrium,combined with other cardiac structural abnormalities,limited experience of doctors,pulmonary vein blood flow velocity of ectopic drainage,and failure to perform SDUS examination are all independent risk factors affecting the missed diagnosis of fetal TAPVD in pregnant women before delivery.关键词
肺静脉异位引流/胎儿/漏诊/产检/频谱多普勒超声/潜在类别模型Key words
ectopic drainage of pulmonary veins/fetus/missed diagnosis/prenatal care/Doppler ultrasound/latent class model引用本文复制引用
许新,邢菊,李真..频谱多普勒超声特征对胎儿肺静脉异位引流的诊断价值及漏诊影响因素分析[J].临床误诊误治,2025,38(20):14-22,9.基金项目
2022年沧州市科技计划自筹经费项目(222106131) （222106131）
