目的:分析自由角M型(FAM)TAPSEZ评分对Ebstein异常(EA)胎儿逆行动脉导管血流(RDAF)的影响。
方法:纳入30例EA和60例正常胎儿的回顾性队列研究。EA组分为两组:有RDAF(EA-RDAF组)和无RDAF(EA-NRDAF组)。FAM用于测量EA和正常胎儿的TAPSE,并计算Z分数。FAM-TAPSEZ评分的差异,孕周(GW),产妇年龄(MA),比较3组二尖瓣-三尖瓣距离(MTD)。FAM-TAPSEZ得分之间的相关性和二元逻辑回归,GW,MA,MTD,和RDAF进行了分析。
结果:EA-RDAF组的FAM-TAPSEZ评分明显低于其他组(p<0.05)。FAM-TAPSEZ-score,GW,MA与RDAF呈负相关(p<0.05),但在TR之间没有发现相关性,MDT,和RDAF(p>0.05)。多因素logistic回归分析显示,FAM-TAPSEZ评分是RDAF的独立影响因素(OR=0.102,p<0.05)。
结论:RV功能障碍是导致EA胎儿RDAF的独立因素,为进一步研究通过宫内治疗延缓和预防RDAF改善RV功能提供了可行的理论依据,避免死亡周期,提高活产率。
OBJECTIVE: To analyze the influence of RV dysfunction evaluated by Free-angle M-mode (FAM) TAPSE Z-score on retrograde ductus arteriosus flow (RDAF) in fetuses with Ebstein anomaly (EA).
METHODS: A retrospective cohort study of 30 EA and 60 normal fetuses were enrolled. The EA group was divided into two groups: with RDAF (EA-RDAF group) and without RDAF (EA-NRDAF group). FAM was used to measure TAPSE of EA and normal fetuses, and Z-scores were calculated. The differences of FAM-TAPSE Z-score, gestational week (GW), maternal age (MA), and mitral valve-tricuspid valve distance (MTD) between three groups were compared. The correlation and binary logistic regression between FAM-TAPSE Z-score, GW, MA, MTD, and RDAF were analyzed.
RESULTS: FAM-TAPSE Z-score was significantly lower in EA-RDAF group compared to other groups (p < 0.05). FAM-TAPSE Z-score, GW, and MA were negatively correlated with RDAF (p < 0.05), but no correlation was found between TR, MDT, and RDAF (p > 0.05). Multivariate logistic regression showed that FAM-TAPSE Z-score was an independent influencing factor for RDAF (OR = 0.102, p < 0.05).
CONCLUSIONS: RV dysfunction is an independent factor leading to RDAF in EA fetus, which provides a feasible theoretical basis for further study on improvement of RV function through intrauterine treatment to delay and prevent the RDAF, to avoid death cycle and improve live-birth rate.