本研究旨在比较二维(2D)彩色多普勒超声(CDU)和四维(4D)超声时空图像相关性(STIC)在孕中期胎儿先天性心脏病中的应用,并分析该病的高危因素。2019年8月至2021年7月,选取135例高度疑似先天性心脏畸形的孕中期患者,在湖州学院附属南太湖医院进行产前筛查。2D-CDU,4DSTIC,所有患者均完成产后检查。2D-CDU,使用4DSTIC和2D-CDU联合4DSTIC检测胎儿心脏畸形并对心脏畸形进行分类。敏感性,特异性,正预测值,2D-CDU的阴性预测值和符合率,比较4DSTIC和2D-CDU联合4DSTIC。2D-CDU的结果,以产后诊断结果为金标准,对4DSTIC和2D-CDU联合4DSTIC筛查进行一致性分析。此外,通过单因素和多因素分析孕妇妊娠因素对胎儿心脏畸形的影响。2D-CDU结合4DSTIC在导管弓视图中显示的切片显示数量明显高于2D-CDU或4DSTIC。主动脉弓,和主动脉短轴。135例孕中期胎儿先天性心脏畸形共45例,2D-CDU检出40、38或42例,4DSTIC或2D-CDU结合4DSTIC,分别。敏感性,特异性,正预测值,2D-CDU联合4D超声在先天性心脏畸形筛查中的阴性预测值和符合率均高于2D-CDU或4DSTIC。Kappa一致性分析表明,4DSTIC和2D-CDU联合4D超声对疑似先天性心脏病胎儿的诊断结果一致(κ>0.75),而2D-CDU与产后诊断符合良好(κ<0.75)。单因素和多因素回归分析显示,年龄≥35岁、孕期饮酒、不良妊娠史和分娩史均为胎儿心脏畸形的独立危险因素,补充叶酸是胎儿心脏畸形的独立保护因素。2D-CDU联合4D超声心动图在孕中期胎儿先天性心脏畸形筛查中可能优于单个2D-CDU或4DSTIC。为了减少胎儿心脏异常的发生,应加强高危孕妇妊娠异常筛查,控制高危因素。
Current study aims to compare the application of two-dimensional (2D) color doppler ultrasound (CDU) and four-dimensional (4D) ultrasound spatiotemporal image correlation (STIC) in fetal congenital heart disease in the second trimester of pregnancy and to analyze the high risk factors of the disease. From August 2019 to July 2021, 135 second-trimester patients with highly suspected congenital heart malformations were selected who underwent prenatal screening at South Taihu Hospital Affiliated to Huzhou University. 2D-CDU, 4D STIC, and postnatal examination were completed in all patients. 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were used to detect fetal cardiac malformations and classify cardiac malformations. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were compared. The results of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC screening were analyzed for consistency using the results of postpartum diagnosis as the gold standard. Moreover, effects of maternal gestational factors on fetal cardiac malformations by univariate and multivariate analysis. 2D-CDU combined with 4D STIC showed significantly higher section display number than 2D-CDU or 4D STIC in the view of ductal arch, aortic arch, and aortic short-axis. A total of 45 cases of fetal congenital heart malformation were detected in 135 patients in the second trimester, 40, 38 or 42 cases were detected by 2D-CDU, 4D STIC or 2D-CDU combined with 4D STIC, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU combined with 4D ultrasound in congenital heart malformation screening were higher than those of 2D-CDU or 4D STIC. Kappa agreement analysis showed that the diagnostic results of 4D STIC and 2D-CDU combined with 4D ultrasound in fetuses with suspected congenital heart malformation were in excellent agreement (κ > 0.75), while 2D-CDU was in good agreement with postpartum diagnosis (κ < 0.75). Univariate and multivariate regression analysis revealed that maternal age ≥ 35, drinking during pregnancy, and history of adverse pregnancy and childbirth were all independent risk factors for fetal cardiac malformations, while folic acid supplementation was an independent protective factor for fetal cardiac malformations. 2D-CDU combined with 4D echocardiography may be superior to single 2D-CDU or 4D STIC in the screening of fetal congenital heart malformation in the second trimester. In order to reduce the incidence of fetal heart anomalies, we should strengthen the screening of pregnancy anomalies in high-risk pregnant women and control the risk factors.