·临床研究·DOI:10.3760/cma.j.issn.1004-4477.2015.09.009资助项目:浙江省科技厅公益性技术应用研究计划项目(2012C33123)作者单位:310016杭州,浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所(童小贞,研究生,现在浙江省义乌市妇幼保健院超声科)通信作者:赵博文,Email:zbwcjp@163.comZ-评分在胎儿主动脉狭窄诊断中的应用童小贞赵博文王蓓潘美彭晓慧陆红妤陈剑【摘要】目的探讨正常胎儿与主动脉狭窄(AS)胎儿主动脉内径Z-评分、主动脉/肺动脉内径比值的差异及Z-评分在AS诊断中的应用价值。方法采用彩色多普勒超声心动图对300例孕龄为16~40周的正常胎儿进行研究,测量收缩末期主动脉瓣环内径(AO)及肺动脉瓣环内径(PA)。以双顶径(BPD)、股骨长径(FL)作为自变量,AO、PA作为应变量建立最佳模型,并分析标准差(SD)与自变量BPD及FL的相关性,计算正常胎儿AO及PA的Z-评分。对106例孕龄为15~40周的AS胎儿进行研究,通过上述回归方程计算AS胎儿AO、PA的Z-评分,计算PA/AO值,与正常胎儿进行统计学比较。分别根据AOZ-评分、PA/AO值及AO百分范围同时计算AS的诊断准确性。结果两组AOZ-评分及PA/AO值差异有统计学意义(P<0.01),PAZ-评分差异无统计学意义(P>0.05)。AS组96.2%胎儿的AOZ-评分<-3,95.3%AS胎儿PA/AO值分布于95%置信区间之外。AOZ-评分对AS的诊断准确性最高,阳性预测值为89.5%,阴性预测值为98.6%,灵敏性为96.2%,特异性为96%,约登指数为0.9223。PA/AO值次之,百分范围的最低。结论胎儿AOZ-评分位于±3之外与PA/AO值增大(>1.4)相结合,在AS的诊断中具有重要的临床应用价值,较百分范围更能准确地定量评估AS胎儿心脏结构的生长发育。【关键词】超声心动描记术;胎儿;主动脉狭窄;生物统计学;Z-评分ApplicationofZ-scoresinthediagnosisoffetalaorticstenosisTongXiaozhen,ZhaoBowen,WangBei,PanMei,PengXiaohui,LuHongyu,ChenJian.DepartmentofDiagnosticUltrasound&Echocardiography,SirRunRunShawHospital,ZhejiangUniversityCollegeofMedicine&SirRunRunShawInstituteofClinicalMedicineofZhejiangUniversity,Hangzhou310016,ChinaCorrespondingauthor:ZhaoBowen,Email:zbwcjp@163.com【Abstract】ObjectiveToexplorethedifferenceinZ-scorereferencerangeforaortameasurements,andpulmonaryartery(PA)/aortic(AO)valveannulardiameterratio(PA/AOratio)betweennormalandaorticstenosis(AS)fetusesandtoevaluatethediagnosticvalueofZ-scoreofaortainfetuseswithAS.MethodsAretrospectivecross-sectionalstudyoffetalcolorDopplerechocardiogramswereundertookfrom300singletonnormalfetuseswithgestationalagerangedfrom16to40weeks.StandardizedfetalechocardiographicmeasurementsincludedAOvalveannulardiameterandPAvalveannulardiameteratend-systole,andPA/AOratiowereobtained.Withstatisticalanalysis,bestmodelwasestablishedforpredictingAOandPAusingbiparietaldiameter(BPD)andfemorallength(FL)asindependentvariables.Thecorrelationsbetweenstandarddeviation(SD)andtwoindependentvariables(BPD,FL)wereanalyzed,andtheAOZ-scoreandPAZ-scoreofnormalfetuseswerecalculated.OnehundredandsixsingletonfetuseswithASwerestudiedwhosegestationalagerangedfrom15to40weeks.TheAOZ-scoreandPAZ-scoreofASfetusesobtainedbyusingaboveregressionequationandPA/AOratioweresubsequentlycalculated.TheAOandPAZ-scoresandPA/AOratiobetweennormalfetusesandASfetuseswerecompared.AndthedetectionrateofASaccordingtoAOZ-score,PA/AOratioandAOpercentilerangewereassessed.ResultsComparedwithnormalfetuses,theZ-scoreofAOandthePA/AOratioinASfetuseswerestatisticallydifferent(P<0.01).WhiletherewasnostatisticaldifferenceofZ-scoreofPAbetweentwogroups(P>0.05).AOZ-scorein96.2%ofASfetuseswerefound<-3,PA/AOratioin95.3%ofASfetuseswerefoundoutside95%CI.ThemethodusingAOZ-scorehadthehighestdetectionrateofAS,thepositive·477·中华超声影像学杂志2015...
