背景 主动脉缩窄的产前诊断筛查的假阴性率高、特异性低

       方法和结果 这项回顾性的研究评价了已出版的孕22±0周（15±4-38±4周）胎儿连续200例正常对照组的主动脉弓和导管Z积分（3-血管及气管切面刚好在降主动脉之前测量）及其比值。其次，这项研究检测了在一个心室和/或大血管比例失衡的队列中筛查或胎儿心脏超声检查连续Z积分鉴别主动脉缩窄胎儿的能力。再次，评估相关心脏缺损、缩窄架及峡部血流涡流的诊断意义。我们研究了44例24±0 周 (17±3-- 37±4 周)的疑诊主动脉缩窄的胎儿，建立接收运行特性曲线。逻辑回归分析法检测Z积分、附加心脏诊断及主动脉缩窄的相关性。发现Z积分有利于需要外科手术与对照组及假阴性患儿的鉴别，接收运行曲线下方的面积较好的表现出了峡部Z积分(0.963)及峡部/导管比值(0.969)。疑诊病例中连续Z积分 >–2 提示心脏结构正常，而Z积分<–2的患儿则需要监测或外科手术。较小的病变不能提高主动脉缩窄的诊断，但峡部涡流提高了真正缩窄与主动脉弓发育不良的比值比16倍。

       结论 峡部Z积分及峡部/导管比值是诊断胎儿主动脉缩窄敏感的预测因素。连续测量及异常的峡部血流方式提高了诊断的特异性，可减小假阳性。

来源：丁香网

Morphological and Physiological Predictors of Fetal Aortic Coarctation

Background— Prenatal diagnosis of aortic coarctation suffers from high false-negative rates at screening and poor specificity.

Methods and Results— This retrospective study tested the applicability of published aortic arch and ductal Z scores (measured just before the descending aorta in the 3-vessel and tracheal view) and their ratio on 200 consecutive normal controls at a median of 22±0 gestational weeks (range, 15±4 to 38±4 weeks). Second, this study tested the ability of serial Z scores to distinguish fetuses with coarctation within a cohort with ventricular and/or great arterial disproportion detected at screening or fetal echocardiography. Third, it evaluated the diagnostic significance of associated cardiac lesions, coarctation shelf, and isthmal flow disturbance. We studied 44 fetuses with suspected coarctation at 24±0 weeks (range, 17±3 to 37±4 weeks). Receiver-operating characteristic curves were created. Logistic regression tested the association between z scores, additional cardiac diagnoses, and coarctation. Good separation was found of isthmal Z scores for cases requiring surgery from controls and false-positive cases, and receiver-operating characteristic curves showed an excellent area under the curve for isthmal Z score (0.963) and isthmal-to-ductal ratio (0.969). Serial isthmal Z scores improved to >–2 in suspected cases with normal outcomes; those requiring surveillance or surgery remained <–2. Minor lesions did not increase the diagnostic specificity of coarctation, but isthmal flow disturbance increased the odds ratio of true coarctation versus arch hypoplasia 16-fold.

Conclusions— Isthmal Z scores and isthmal-to-ductal ratio are sensitive indicators of fetal coarctation. Serial measurements and abnormal isthmal flow patterns improve diagnostic specificity and may reduce false positives.

source：circulation.com