胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用

doi:10.3877/cma.j.issn.1672-6448.2023.08.013

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (08) : 860 -865. doi: 10.3877/cma.j.issn.1672-6448.2023.08.013

妇产科超声影像学

胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用

张璟璟, 赵博文^†(

), 潘美, 彭晓慧, 毛彦恺, 潘陈可, 朱玲艳, 朱琳琳, 蓝秋晔

310016　杭州，浙江大学医学院附属邵逸夫医院超声科　浙江省胎儿心脏超声诊断技术指导中心　浙江大学邵逸夫临床医学研究所;321200　金华，浙江省武义县妇幼保健院超声科
310016　杭州，浙江大学医学院附属邵逸夫医院超声科　浙江省胎儿心脏超声诊断技术指导中心　浙江大学邵逸夫临床医学研究所
321200　金华，浙江省武义县妇幼保健院超声科
310016　杭州，浙江大学医学院附属儿童医院心血管科

收稿日期:2023-05-15 出版日期:2023-08-01
通信作者: 赵博文
基金资助:
浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055); 浙江省基础公益研究计划项目(LGF20H180013)

Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography

Jingjing Zhang, Bowen Zhao^†(), Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan

Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China;Department of Ultrasound, Women & Children Hospital of Wuyi, Jinhua 321200, China
Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
Department of Ultrasound, Women & Children Hospital of Wuyi, Jinhua 321200, China
Department of Cardiovascular Medicine, Zhejiang University School of Medicine Affiliated Children's Hospital, Hangzhou 310016, China

Received:2023-05-15 Published:2023-08-01
Corresponding author: Bowen Zhao

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引用本文：

张璟璟, 赵博文, 潘美, 彭晓慧, 毛彦恺, 潘陈可, 朱玲艳, 朱琳琳, 蓝秋晔. 胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 860-865.

Jingjing Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan. Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 860-865.

目的

应用胎儿超声心动图测量McGoon指数（MGI），探讨不同孕龄的胎儿及不同肺血流量状态下MGI的变化。

方法

回顾性选取2020年6月至2021年8月在浙江大学医学院附属邵逸夫医院超声科接受超声心动图检查的胎儿。超声心动图检查未见异常的218例胎儿为正常组（依据孕龄分为4个亚组）；胎儿超声心动图考虑肺动脉血流减少或闭锁的先天性心脏病胎儿66例（病例组1），考虑主动脉血流减少或离断胎儿19例（病例组2）。超声心动图测量胎儿的MGI，比较分析各组之间测量结果的差异。

结果

正常对照组不同孕龄的4个亚组间（18~21⁺⁶周、22~25⁺⁶周、26~29⁺⁶周、30~33⁺⁶周）MGI分别为1.39±0.35、1.38±0.20、1.38±0.21、1.40±0.19，差异无统计学意义（P>0.05）。正常对照组MGI为1.38±0.22；肺动脉血流减少或闭锁组MGI为1.16±0.19，低于其他2组，差异有统计学意义（P<0.05）；主动脉血流减少或离断组MGI为1.42±0.25，与正常组比较差异无统计学意义（P>0.05）。

结论

孕18~33⁺⁶周阶段正常胎儿MGI相对恒定，不随孕龄的增加而改变；超声心动图定量测量胎儿MGI可评价不同先天性心脏病胎儿的肺血流量，一定程度上反映肺血管发育情况。

关键词: 先天性心脏病, 胎儿, 超声心动图, McGoon指数, 肺动脉狭窄

Objective

To investigate the dynamic changes of McGoon index (MGI) in fetuses with different gestational weeks or different pulmonary blood flow patterns by fetal echocardiography.

Methods

Fetuses who underwent echocardioimagedata examination at the Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from June 2020 to August 2021 were included, of whom 218 with no abnormalities detected by echocardiography were included in a normal group (further subdivided into 4 subgroups based on gestational age), 66 had decreased pulmonary blood flow or pulmonary atresia (case group 1), and 19 had decreased aortic blood flow or interruption of the aortic arch (case group 2). MGI was measured and calculated by echocardiography, and its differences among groups were compared.

Results

MGI in the four subgroups of the normal control group (18-21⁺⁶ weeks, 22-25⁺⁶ weeks, 26-29⁺⁶ weeks, and 30-33⁺⁶ weeks) was (1.39±0.35), (1.38±0.20), (1.38±0.21), and (1.40±0.19), respectively, and the difference among the four subgroups was not statistically significant (P>0.05). MGI in the normal control group was (1.38±0.22). MGI in case group 1 was (1.16±0.19), significantly lower than that of the other two groups (P<0.05). MGI in case group 2 was (1.42±0.25), which was comparable to that of the normal control group (P>0.05).

Conclusions

MGI in normal fetuses with a gestational age of 18-33+6 weeks is constant, and it does not change with increasing gestational age. Quantitative measurement of fetal MGI by echocardiography can evaluate the pulmonary blood flow of fetuses with different congenital heart diseases, reflecting, to some extent, the development of pulmonary blood vessels.

Key words: Congenital heart disease, Fetus, Echocardiography, McGoon index, Pulmonary artery stenosis

图1 超声测量正常胎儿McGoon指数。图a为肺动脉长轴切面分别测量胎儿左肺动脉和右肺动脉内径；图b为胎儿胸腹部长轴切面测量正常胎儿膈肌水平降主动脉内径注：RPA为右肺动脉；LPA为左肺动脉

图2 超声测量法洛四联症胎儿McGoon指数。图a为法洛四联症胎儿肺动脉长轴切面显示肺动脉主干及左肺动脉和右肺动脉明显狭窄，分别测量左肺动脉和右肺动脉内径；图b为胎儿胸腹部长轴切面测量法洛四联症胎儿膈肌水平降主动脉内径注：RPA为右肺动脉；LPA为左肺动脉；Des-AO为降主动脉内径

表1 正常对照组与病例组各组间超声心动图参数比较（）

组别	例数	H/C	PA/AO	MGI
正常对照组	218	0.25±0.04	1.278±0.133	1.38±0.22
肺动脉血流减少或闭锁组	66	0.28±0.05^a	0.745±0.276^ab	1.16±0.19^ab
主动脉血流减少或离断组	19	0.26±0.03	1.302±0.746	1.42±0.25
F值		7.79	117.8	27.78
P值		<0.01	<0.01	<0.01

表1 正常对照组与病例组各组间超声心动图参数比较（）

组别	例数	H/C	PA/AO	MGI
正常对照组	218	0.25±0.04	1.278±0.133	1.38±0.22
肺动脉血流减少或闭锁组	66	0.28±0.05^a	0.745±0.276^ab	1.16±0.19^ab
主动脉血流减少或离断组	19	0.26±0.03	1.302±0.746	1.42±0.25
F值		7.79	117.8	27.78
P值		<0.01	<0.01	<0.01

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