McGoon指数及Z-评分在胎儿右心室流出道梗阻性疾病中的定量研究

doi:10.3877/cma.j.issn.1672-6448.2023.12.006

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (12) : 1254 -1259. doi: 10.3877/cma.j.issn.1672-6448.2023.12.006

妇产科超声影像学

McGoon指数及Z-评分在胎儿右心室流出道梗阻性疾病中的定量研究

余炫玲¹, 赵博文²^,^†(

), 潘美², 彭晓慧², 娄杰², 陈冉², 蒋贤辉³, 张璟璟²

^1. 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;310030　杭州市儿童医院超声科
^2. 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
^3. 310030　杭州市儿童医院超声科

收稿日期:2022-12-16 出版日期:2023-12-01
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); 杭州市卫生计生科技计划重点项目(OO20190172)

Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction

Xuanling Yu¹, Bowen Zhao²^,^†(), Mei Pan², Xiaohui Peng², Jie Lou², Ran Chen², Xianhui Jiang³, Jingjing Zhang²

^1. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College 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, Hangzhou Children’s Hospital, Hangzhou 310030, China
^2. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College 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
^3. Department of Ultrasound, Hangzhou Children’s Hospital, Hangzhou 310030, China

Received:2022-12-16 Published:2023-12-01
Corresponding author: Bowen Zhao

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引用本文：

余炫玲, 赵博文, 潘美, 彭晓慧, 娄杰, 陈冉, 蒋贤辉, 张璟璟. McGoon指数及Z-评分在胎儿右心室流出道梗阻性疾病中的定量研究[J]. 中华医学超声杂志（电子版）, 2023, 20(12): 1254-1259.

Xuanling Yu, Bowen Zhao, Mei Pan, Xiaohui Peng, Jie Lou, Ran Chen, Xianhui Jiang, Jingjing Zhang. Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1254-1259.

目的

探讨Z-评分及McGoon指数（MGI）在评估胎儿右心室流出道梗阻（RVOTO）中的应用价值。

方法

选取自2020年6月至2022年1月在浙江大学医学院附属邵逸夫医院超声科经胎儿超声心动图诊断为RVOTO的胎儿67例，根据梗阻程度将观察组分为4组[轻度肺动脉狭窄（PS）组17例、中重度PS组16例、法洛四联症（TOF）组19例、肺动脉闭锁组15例]，选取同期检查的正常胎儿70例作为对照组，比较5组的主动脉内径Z-评分（AO Z-评分）、肺动脉内径Z-评分（PA Z-评分）、左肺动脉内径Z-评分（LPA Z-评分）、右肺动脉内径Z-评分（RPA Z-评分）及MGI的差异。

结果

随着RVOTO程度加重，MGI呈下降趋势；PA及LPA、RPA的Z-评分整体呈下降趋势；AO Z-评分整体呈上升趋势，差异均有统计学意义（均P<0.05）。对照组与轻度PS组比较，PA Z-评分、RPA Z-评分及AO Z-评分差异有统计学意义（均P<0.05）。对照组与中重度PS组、TOF组、肺动脉闭锁组比较，MGI及各血管Z-评分差异均有统计学意义（均P<0.05）。轻度PS组与中重度PS组比较，PA、LPA的Z-评分差异均有统计学意义（均P<0.05）。轻度PS组与TOF组比较，MGI、肺动脉及其分支Z-评分差异均有统计学意义（均P<0.05）；轻度PS组与肺动脉闭锁组比较，MGI、PA及LPA的Z-评分差异均有统计学意义（均P<0.05）；中重度PS组与TOF组比较AO Z-评分差异有统计学意义（P<0.05）；中重度PS组与肺动脉闭锁组比较，RPA Z-评分、AO Z-评分差异有统计学意义（均P<0.05）；TOF组与肺动脉闭锁组比较，RPA Z-评分差异有统计学意义（P<0.05）。

结论

MGI及Z-评分可定量分析比较正常组及不同程度RVOTO胎儿肺动脉及其分支的发育情况。PS程度相近的胎儿肺动脉发育情况评估，Z-评分优于MGI。

关键词: 法洛四联症, 肺动脉狭窄, 肺动脉闭锁, 右心室流出道梗阻, McGoon指数, Z-评分

Objective

To evaluate the value of Z-score and McGoon index (MGI) in the diagnosis of fetal right ventricular outflow tract obstruction (RVOTO).

Methods

Sixty-seven fetuses with RVOTO diagnosed by fetal echocardiography at Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from June 2020 to January 2022 were included. According to the degree of obstruction, the fetuses was divided into 4 groups: mild pulmonary stenosis (PS) group (n=17), moderate and severe PS group (n=16), tetralogy of Fallot (TOF) group (n=19), and pulmonary atresia group (n=15). Seventy normal fetuses who underwent examination during the same period were selected as controls. The differences in aortic (AO) diameter Z-score, pulmonary artery (PA) diameter Z-score, left pulmonary artery (LPA) diameter Z-score, right pulmonary artery (RPA) diameter Z-score, and MGI were compared among the five groups.

Results

With the aggravation of RVOTO, MGI showed a downward trend, the PA, LPA, and RPA Z-scores also showed a downward trend, and the AO Z-score showed a upward trend; the differences were statistically significant (P<0.05). There were significant differences in the PA, RPA, and AO Z-scores between the control group and mild PS group (P<0.05). There were significant differences in MGI and Z-scores among the control group, moderate and severe PS group, and TOF group, and pulmonary atresia group (P<0.05). There were significant differences in PA and LPA Z-scores between the mild PS group and moderate and severe PS group (P<0.05 for both), in MGI and Z-scores of the pulmonary artery and its branches between the mild PS group and TOF group (P<0.05 for both), in MGI and PA and LPA Z-scores between the mild PS group and pulmonary atresia group (P<0.05 for all), in AO Z-score between the moderate and severe PS group and TOF group (P<0.05), in RPA and AO Z-scores between the moderate and severe PS and pulmonary atresia group (P<0.05 for both), and in RPA Z-score between the TOF group and pulmonary atresia group (P<0.05).

Conclusion

MGI and Z-score can be used to quantitatively assess and compare the development of the pulmonary artery and its branches between normal fetuses and RVOTO fetuses, and provide reference information for accurate quantitative analysis of fetal pulmonary artery development among RVOTO of different severities. In the comparison between groups with similar degree of RVOT, Z-score is superior to MGI.

Key words: Tetralogy of Fallot, Pulmonary artery stenosis, Pulmonary atresia, Right ventricular outflow tract obstruction, McGoon index, Z-score

图1 26周肺动脉狭窄胎儿Z评分测量图。图a为肺动脉Z-评分测量图；图b为右肺肺动脉Z-评分测量图；图c为左肺肺动脉Z-评分测量图；图d为主动脉Z-评分测量图

表1 正常对照组与病例组各组间超声心动图参数比较[

或M（P₂₅，P₇₅）]

组别	例数	MGI	PAZ1	PAZ2	LPAZ1	LPAZ2	RPAZ1	RPAZ2	AOZ1	AOZ2
对照组	70	1.40±0.21	0.32（-0.51，1.06）	0.22（-0.69，1.43）	0.55（-0.09，1.12）	0.54±1.20	0.59（-0.18，1.11）	0.59（-0.16，1.21）	-0.20（-1.14，0.85）	-0.12±1.94
轻度PS组	17	1.29±0.28	-0.50±1.11^a	-0.85±1.18^a	0.16±1.48	0.07±1.87	-0.20±1.53^a	-0.34±1.56^a	1.65±1.22^a	1.59±1.43^a
中重度PS组	16	1.19±0.22 ^a	-3.64（-4.76，3.25）^ab	-4.50±1.28^ab	0.909±1.36^ab	-1.16±1.42^ab	-0.97±1.51^a	-1.19±1.51^a	1.09±1.95^a	1.10±2.18^a
TOF组	19	1.06±0.20^ab	-3.46±1.76^ab	-3.69±1.62^ab	-0.89±0.90^ab	-1.01±0.97^ab	-1.23±1.17^ab	-1.34±1.26^ab	2.20±0.87^ac	2.60±1.14^ac
肺动脉闭锁组	15	1.05±0.41^ab	-8.85（-15.44，2.05）^ab	-8.10（-17.86，2.26）^ab	-0.65（-3.34，0.46）^ab	-1.01（-3.42，0.69）^ab	0.50（-1.00，1.11）^c	-0.01（-1.01，0.58）^ad	2.10±1.58^ac	2.14±2.13^a
统计值		F=11.23	H=80.48	H=84.55	H=36.38	H=36.67	H=32.51	H=36.44	H=54.78	F=11.79
P值		<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<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[

或M（P₂₅，P₇₅）]

组别	例数	MGI	PAZ1	PAZ2	LPAZ1	LPAZ2	RPAZ1	RPAZ2	AOZ1	AOZ2
对照组	70	1.40±0.21	0.32（-0.51，1.06）	0.22（-0.69，1.43）	0.55（-0.09，1.12）	0.54±1.20	0.59（-0.18，1.11）	0.59（-0.16，1.21）	-0.20（-1.14，0.85）	-0.12±1.94
轻度PS组	17	1.29±0.28	-0.50±1.11^a	-0.85±1.18^a	0.16±1.48	0.07±1.87	-0.20±1.53^a	-0.34±1.56^a	1.65±1.22^a	1.59±1.43^a
中重度PS组	16	1.19±0.22 ^a	-3.64（-4.76，3.25）^ab	-4.50±1.28^ab	0.909±1.36^ab	-1.16±1.42^ab	-0.97±1.51^a	-1.19±1.51^a	1.09±1.95^a	1.10±2.18^a
TOF组	19	1.06±0.20^ab	-3.46±1.76^ab	-3.69±1.62^ab	-0.89±0.90^ab	-1.01±0.97^ab	-1.23±1.17^ab	-1.34±1.26^ab	2.20±0.87^ac	2.60±1.14^ac
肺动脉闭锁组	15	1.05±0.41^ab	-8.85（-15.44，2.05）^ab	-8.10（-17.86，2.26）^ab	-0.65（-3.34，0.46）^ab	-1.01（-3.42，0.69）^ab	0.50（-1.00，1.11）^c	-0.01（-1.01，0.58）^ad	2.10±1.58^ac	2.14±2.13^a
统计值		F=11.23	H=80.48	H=84.55	H=36.38	H=36.67	H=32.51	H=36.44	H=54.78	F=11.79
P值		<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

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Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction

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Quantitative study of McGoon index and Z-scores in fetuses with right ventricular outflow tract obstruction