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中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (09) : 874 -879. doi: 10.3877/cma.j.issn.1672-6448.2020.09.010

所属专题： 妇产科超声影像学； 文献； 妇产科超声；

妇产科超声影像学

三维能量多普勒及彩色多普勒超声评估先天性心脏病胎儿脑血流灌注的研究
杨忠1, 邓学东1,†(), 姜纬1, 殷林亮1, 潘琦1, 梁泓1, 马建芳1, 苟中山1, 王珍琦1   
  1. 1. 215000　江苏苏州，南京医科大学附属苏州医院超声中心
  • 收稿日期:2019-09-20 出版日期:2020-09-01
  • 通信作者: 邓学东
  • 基金资助:
    江苏省卫计委面上科研项目(H201544); 苏州市科技局科研项目(SYS201773)

Three-dimensional power Doppler and color Doppler ultrasound for evaluation of cerebral blood perfusion in fetuses with congenital heart disease

Zhong Yang1, Xuedong Deng1,†(), Wei Jiang1, Linliang Yin1, Qi Pan1, Hong Liang1, Jianfang Ma1, Zhongshan Gou1, Zhenqi Wang1   

  1. 1. Center for Medical Ultrasound, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, China
  • Received:2019-09-20 Published:2020-09-01
  • Corresponding author: Xuedong Deng
  • About author:
    Corresponding author: Deng Xuedong, Email:
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杨忠, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 苟中山, 王珍琦. 三维能量多普勒及彩色多普勒超声评估先天性心脏病胎儿脑血流灌注的研究[J]. 中华医学超声杂志（电子版）, 2020, 17(09): 874-879.

Zhong Yang, Xuedong Deng, Wei Jiang, Linliang Yin, Qi Pan, Hong Liang, Jianfang Ma, Zhongshan Gou, Zhenqi Wang. Three-dimensional power Doppler and color Doppler ultrasound for evaluation of cerebral blood perfusion in fetuses with congenital heart disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 874-879.

目的

应用三维能量多普勒及彩色多普勒超声研究先天性心脏病胎儿脑血流灌注。

方法

选取2017年1月至2018年8月在南京医科大学附属苏州医院进行二维彩色多普勒超声测量的156例孕妇（胎儿正常对照组105例，胎儿先天性心脏病组51例），应用脉冲多普勒测量胎儿脐动脉搏动指数（PI）及大脑中动脉PI值，并计算大脑中动脉PI与脐动脉PI比值（CPR）。同时应用三维能量多普勒超声成像，通过虚拟器官计算机辅助分析技术勾勒并计算大脑中动脉近心端区域血流灌注参数：血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI），从而评估2组胎儿脑血流灌注情况。对脐动脉、大脑中动脉各组数据所测数据进行Z值校正，再采用方差分析比较组间差异，然后利用Bonferron法进行正常组与先天性心脏病[完全型大动脉转位（TGA），左心发育不良综合征（HLHS），左心梗阻性疾病（LSOL），右心梗阻性疾病（RSOL）]各组的两两比较。

结果

与正常对照组相比，HLHS和LSOL胎儿大脑中动脉PI（1.27±0.30 vs 1.30±0.30 vs 2.15±0.48）和CPR（1.26±0.29 vs 1.32±0.18 vs 1.92±0.58）均减少，大脑中动脉VI（71.71±19.57 vs 68.11±14.35 vs 42.19±16.29）、FI（88.71±12.53 vs 81.80±14.21 vs 50.15±17.76）和VFI（34.70±7.17 vs 35.98±6.52 vs 20.90±11.06）均增加，差异均具有统计学意义（P均<0.001），RSOL、TGA胎儿与正常胎儿之间大脑中动脉VI、FI和VFI比较，差异均无统计学意义（P>0.05）。

结论

先天性心脏病胎儿脑血流灌注明显增加，特别是HLHS和LSOL胎儿，产前应用三维能量多普勒及彩色多普勒能有效评估此类先天性心脏病胎儿脑血流灌注。

关键词: 大脑中动脉, 先天性心脏病, 脑血流
Objective

To evaluate cerebral blood perfusion in fetuses with congenital heart disease by three-dimensional power Doppler and color Doppler ultrasound.

Methods

The umbilical artery pulsation index (UA-PI) and the middle cerebral artery pulsation index (MCA-PI) were calculated by two-dimensional color Doppler ultrasound in 156 fetuses at Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to August 2018, including 105 normal fetuses (control group) and 51 fetuses with congenital heart disease. The ratio of MCA-PI to UA-PI was also calculated (CPR=MCA-PI/UA-PI). Three-dimensional power Doppler ultrasound combined with virtual organ computer-assisted analysis (VOCAL) technology was utilized to assess blood perfusion parameters of the proximal part of the middle cerebral artery, including vascularization index (VI), blood flow index (FI), and vascularization blood flow index (VFI), to evaluate the fetal cerebral perfusion during pregnancy. Z value was corrected for the measured data. ANOVA was then used to compare the above parameters among normal fetuses and fetuses with different congenital heart diseases including transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS), left sided obstructive lesions (LSOL), and right sided obstructive lesions (RSOL), followed by Bonferronni's method for pairwise comparisons.

Results

Compared with the normal control group, there was a significant reduction in MCA-PI (1.27±0.30 vs 1.30±0.30 and 2.15±0.48) and CPR (1.26±0.29 vs 1.32±0.18 and 1.92±0.58), and a significant increase in VI (71.71±19.57 vs 68.11±14.35 and 42.19±16.29), FI (88.71±12.53 vs 81.80±14.21 and 50.15±17.76), and VFI (34.70±7.17 vs 35.98±6.52 and 20.90±11.06) in HLHS fetuses and LSOL fetuses (P<0.001 for all). However, there was no significant difference in MCA VI, F, or VFI among the RSOL fetuses, TGA fetuses, and the normal fetuses (P>0.05).

Conclusion

Fetal cerebral perfusion with congenital heart disease significantly increases, especially in fetuses with HLHS and LSOL. Prenatal application of three-dimensional power Doppler and color Doppler ultrasound can effectively evaluate cerebral perfusion in fetuses with these congenital heart diseases.

Key words: Ultrasound, Congenital heart disease, Brain blood flow
图1 三维能量多普勒显示大脑中动脉血流，激活虚拟器官计算机辅助分析直方图，自动获得各动脉区域血流灌注参数：血管化指数、血流指数和血管化血流指数
表1 脐动脉、大脑中动脉各组数据Z分数比较（±s）
组别 例数 脐动脉PI 大脑中动脉PI CPR 大脑中动脉VI 大脑中动脉FI 大脑中动脉VFI
正常组 105 1.15±0.15 2.15±0.48 1.92±0.58 42.19±16.29 50.15±17.76 20.90±11.06
TGA 6 1.28±0.12 2.36±0.36 1.86±0.36 50.27±15.08 55.24±14.36 22.59±6.56
HLHS 12 1.03±0.26 1.27±0.30 1.26±0.29 71.71±19.57 88.71±12.53 34.70±7.17
LSOL 16 1.00±0.20 1.30±0.30 1.32±0.18 68.11±14.35 81.80±14.21 35.98±6.52
RSOL 17 1.22±0.32 1.65±0.59 1.36±0.39 37.34±11.27 43.54±13.06 20.61±9.40
F值 ? 6.063 20.368 9.545 17.519 27.014 12.008
P值 ? <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
表2 脐动脉、大脑中动脉各组数据Z分数与正常组两两比较
因变量 与正常组比较组 平均值差值 标准误差 P值 95%可信区间
脐动脉PI TGA -0.1282 0.08474 0.133 -0.2963~-0.0399
HLHS 0.1212 0.06240 0.055 0.0026~0.2450
LSOL 0.1436 0.05542 0.011 0.0337~0.2536
RSOL -0.0750 0.05511 0.176 -0.1842~0.0342
大脑中动脉PI TGA -0.2088 0.19357 0.283 -0.5924~0.1747
HLHS 0.8795 0.14254 <0.001 0.5970~1.1619
LSOL 0.8468 0.12661 <0.001 0.5959~1.0977
RSOL 0.4967 0.12359 <0.001 0.2518~0.7416
CPR TGA 0.0505 0.21389 0.814 -0.3738~0.4748
HLHS 0.6542 0.15751 <0.001 0.3418~0.9667
LSOL 0.5977 0.13990 <0.001 0.3202~0.8753
RSOL 0.5511 0.13106 <0.001 0.2914~0.8108
大脑中动脉VI TGA -8.0751 6.71190 0.231 -21.3752~5.2250
HLHS -29.5193 4.94250 <0.001 -39.3132~-19.7254
LSOL -25.9185 4.39010 <0.001 -34.6177~-17.2192
RSOL 4.8510 4.28523 0.260 -3.6405~13.3424
大脑中动脉FI TGA -5.0751 6.86360 0.461 -18.6758~8.5256
HLHS -38.5459 5.05421 <0.001 -48.5612~-28.5307
LSOL -31.6274 4.48932 <0.001 -40.5233~-22.7315
RSOL 6.6250 4.38209 0.133 -2.0584~15.3084
大脑中动脉VFI TGA -1.9804 4.18243 0.637 -10.2681~6.3074
HLHS -14.0929 3.07985 <0.001 -20.1958~-7.9899
LSOL -15.3687 2.73563 <0.001 -20.7895~-9.9479
RSOL 0.0010 2.67029 1.000 -5.2903~5.2924
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