孕中晚期胎儿主动脉弓狭窄的超声诊断参数分析及其影响因素分析

摘要 目的：探究孕中晚期胎儿主动脉弓狭窄的超声诊断参数分析，并就超声诊断参数对孕中晚期胎儿主动脉弓狭窄的影响因素开展分析。方法：选择2020年7月至2021年7月于我院就诊后被确诊为孕中晚期主动脉弓狭窄的40例胎儿为狭窄组，另取同期体格检查正常的40例胎儿为对照组，以胎儿出生后超声心动图检测或尸检结果为金标准，比较两组胎儿超声指标Z-分数（AI Z-score）、升主动脉Z-分数（AO Z-score）、主动脉峡部/升主动脉（AI/AO）差异，分别绘制AI Z-score、AO Z-score以及AI/AO对孕中晚期胎儿主动脉弓狭窄的诊断ROC曲线，并计算其曲线下面积（AUC），最后采用Logistic回归分析的方式计算孕中晚期胎儿主动脉弓狭窄影响因素。结果：（1）窄缩组胎儿的超声参数AI Z-score、AO Z-score以及AI/AO均明显低于对照组（P<0.05）；（2）AI/AO为孕中晚期胎儿主动脉弓狭窄的危险因素（P<0.05）；（3）AI Z-score、AO Z-score、AI/AO以及联合检测对胎儿主动脉弓狭窄的诊断AUC分别为0.801（95% CI=0.691-0.910，P<0.001）、0.835（95% CI=0.739-0.932，P<0.001）、0.843（95% CI=0.757-0.929，P<0.001）、0.920（95% CI=0.865-0.975，P<0.001），截断值分别为-1.64、-1.47和0.535，诊断灵敏度和特异度分别为72.50%和72.50%、77.50%和77.50%、75.00%和80.00%、85.00%和82.50%。结论：超声诊断对孕中晚期胎儿主动脉弓狭窄具有较好的诊断价值，其指标AI Z-score、AO Z-score、AI/AO能够量化分析孕中晚期胎儿主动脉弓狭窄风险，可以考虑将其应用于临床中。

Analysis of Ultrasonic Diagnostic Parameters and Influencing Factors of Fetal Aortic Arch Stenosis in The Second and Third Trimester of Pregnancy

ABSTRACT Objective: To explore the analysis of ultrasonic diagnostic parameters of fetal aortic arch stenosis in the second and third trimester of pregnancy, and analyze the influencing factors of ultrasonic diagnostic parameters on fetal aortic arch stenosis in the second and third trimester of pregnancy. Methods: From July 2020 to July 2021, 40 fetuses diagnosed with aortic arch stenosis in the second and third trimester of pregnancy were selected as the stenosis group, and 40 fetuses with normal physical examination in the same period were selected as the matched group. The results of fetal echocardiography or autopsy after birth were taken as the gold standard. Compare the differences of fetal ultrasound indexes Z- score (AI Z-score), ascending aorta Z- score (AO Z-score) and aortic isthmus/ascending aorta (AI/AO) between the two groups, draw the diagnostic ROC curves of AI Z-score, AO Z-score and AI/AO for fetal aortic arch stenosis in the second and third trimester of pregnancy, and calculate the area under the curve (AUC). Results: (1) The ultrasound parameters AI Z-score, AO Z-score and AI/AO of fetuses in the stenosis group were lower than those in the matched group (P<0.05); (2) AI/AO was a risk factor for fetal aortic arch stenosis in the second and third trimesters (P<0.05); (3) AI Z-score, AO Z-score, AI/AO The AUC of AO and combined detection for the diagnosis of fetal aortic arch stenosis were 0.801 (95% CI=0.691-0.910, P<0.001), 0.835 (95% CI=0.739-0.932, P<0.001), 0.843 (95% CI=0.757), respectively -0.929, P<0.001), 0.920 (95% CI=0.865-0.975, P<0.001), the cutoff values were -1.64, -1.47 and 0.535, respectively, and the diagnostic sensitivity and specificity were 72.50%, 72.50%, and 77.50%, and 77.50%, 75.00% and 80.00%, 85.00% and 82.50%. Conclusion: Ultrasound diagnosis has a good diagnostic value for fetal aortic arch stenosis in the second and third trimester of pregnancy, and its indicators AI Z-score, AO Z-score and AI/AO can quantitatively analyze the risk of fetal aortic arch stenosis in the second and third trimester of pregnancy, so it can be considered for clinical application.