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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (12) : 1197 -1202. doi: 10.3877/cma.j.issn.1672-6448.2020.12.010

所属专题: 文献

妇产科超声影像学

二维斑点追踪技术评估超重及肥胖女性妊娠期胎儿心室收缩功能的研究
赵联璧1, 赵美玲1, 侯娜1, 张琳1, 袁丽君1,()   
  1. 1. 710038 西安,空军军医大学唐都医院超声诊断科
  • 收稿日期:2020-06-10 出版日期:2020-12-01
  • 通信作者: 袁丽君
  • 基金资助:
    科技部国家重点研发计划项目(2017YFC0113800); 国家自然科学基金(81901861)

Evaluation of fetal ventricular systolic function in overweight and obese women during pregnancy by two-dimensional speckle tracking technique

Lianbi Zhao1, Meiling Zhao1, Na Hou1, Lin Zhang1, Lijun. Yuan1,()   

  1. 1. Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
  • Received:2020-06-10 Published:2020-12-01
  • Corresponding author: Lijun. Yuan
  • About author:
    Corresponding author: Yuan Lijun, Email:
引用本文:

赵联璧, 赵美玲, 侯娜, 张琳, 袁丽君. 二维斑点追踪技术评估超重及肥胖女性妊娠期胎儿心室收缩功能的研究[J/OL]. 中华医学超声杂志(电子版), 2020, 17(12): 1197-1202.

Lianbi Zhao, Meiling Zhao, Na Hou, Lin Zhang, Lijun. Yuan. Evaluation of fetal ventricular systolic function in overweight and obese women during pregnancy by two-dimensional speckle tracking technique[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(12): 1197-1202.

目的

应用二维斑点追踪技术评价超重及肥胖女性妊娠期胎儿心室收缩功能。

方法

选取空军军医大学唐都医院2019年6月至2020年3月单胎妊娠的孕妇80例,所有孕妇均于孕24周行常规胎儿超声心动图及二维斑点追踪成像检查。依据孕前体质量指数(BMI)将研究对象分为正常对照组30例、超重组27例和肥胖组23例。采用常规超声心动图及二维斑点追踪技术,对各组胎儿心脏结构、常规心室舒张及收缩功能指标、全心整体球形指数(GSI)以及左、右心室心内膜整体纵向应变(GLS)和右心室游离壁应变(FWSt)进行评价及比较分析。

结果

肥胖组、超重组与正常对照组的胎儿左、右房室横径,心脏面积,心胸面积比及四腔心横径、长径,GSI比较,差异均无统计学意义(P均>0.05)。各组胎儿二、三尖瓣口血流E/A值及瓣环运动速度e/a值差异均无统计学意义,肥胖组二、三尖瓣瓣环收缩期运动速度s较正常对照组及超重组均降低,差异均有统计学意义(P均<0.05)。各组胎儿左心室射血分数,左、右心室面积变化率,二尖瓣环收缩期位移及三尖瓣环收缩期位移比较,差异均无统计学意义(P均>0.05)。左、右心室GLS,及右心室FWSt在正常对照组、超重组、肥胖组均依次逐渐减低,组间差异均有统计学意义(P均<0.05)。

结论

超重女性妊娠可能会使胎儿心肌功能发生改变,左、右心室纵向应变各参数指标可以较好地反映超重及肥胖女性妊娠所引起的胎儿心肌收缩功能改变,有利于孕期随访观察及指导孕妇体重管理。

Objective

To evaluate fetal ventricular systolic function in overweight and obese women during pregnancy by two-dimensional speckle tracking technique.

Methods

Eighty women with singleton pregnancy at Tangdu Hospital of Air Force military Medical University from June 2019 to March 2020 were selected. All pregnant women underwent regular and two-dimensional speckle tracking (2D-STI) fetal echocardiography at 24 weeks of gestation. According to the pre-pregnancy body mass index (BMI), they were divided into a normal control group (n=30), an overweight group (n=27), and an obese group (n=23). Regular and 2D-STI fetal echocardiography was performed for evaluation of fetal cardiac structure, routine indexes of ventricular diastolic and systolic function, global spherical index (GSI), left and right ventricle global longitudinal strain (GLS), and right ventricle free wall strain (FWSt). All the echocardiographic parameters were compared among groups.

Results

There was no significant difference in left and right atrial transverse diameter, left and right ventricular transverse diameter, cardiac area, cardio-thoracic area ratio, cardiac transverse diameter, cardiac longitudinal diameter, or GSI among the three groups (P>0.05). There was also no significant difference in mitral and tricuspid flow velocity E/A or mitral and tricuspid annular velocity e/a among the groups. The systolic velocity of the mitral and tricuspid annulus in obese group was significantly lower than that of the normal control group and overweight group (P<0.05). There was no significant difference in left ventricular ejection fraction (EF), left and right ventricular fraction area change (FAC), mitral annular plane systolic excursion (MAPSE), or tricuspid annular plane systolic excursion (TAPSE) among the groups (P>0.05), but there was a significant difference in left and right ventricular GLS and right ventricular FWSt among the groups. The left ventricular GLS, right ventricular GLS, and right ventricular FWSt decreased gradually from the normal control group to the overweight group and obesity group (P<0.05).

Conclusion

Pregnancy in overweight women may alter fetal cardiac function. The parameters of left and right ventricular longitudinal strain can better reflect the changes of fetal myocardial contractility in overweight and obese pregnant women and are useful in the guidance of weight management and follow-up observation during pregnancy.

图1 胎儿心脏二维斑点追踪技术应变测量图像。二维斑点追踪技术自动识别胎儿心脏心内膜原始二维像素并实时跟踪,根据瓣膜启闭确定时相,计算心肌应变指标
图2 胎儿心脏二维斑点追踪分析图像。利用二维斑点追踪技术可获得胎儿左、右心室心内膜整体纵向应变(GLS)及胎儿右心室游离壁应变(FWSt)
表1 正常对照组、超重组与肥胖组一般资料比较(
xˉ
±s
表2 正常对照组、超重组、肥胖组心脏结构参数比较(
xˉ
±s
表3 正常对照组、超重组、肥胖组心脏多普勒超声指标的变化(
xˉ
±s
表4 正常对照组、超重组、肥胖组心脏收缩功能及应变指标比较(x±s)
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