Assessment of fetal cardiac function in women with hyperthyroidism during pregnancy using two-dimensional speckle tracking imaging technique
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摘要:
目的 探究二维斑点追踪技术评估妊娠期甲状腺功能亢进患者胎儿心功能。 方法 选取2021年8月~2022年6月于我院就诊的妊娠期甲亢患者作为研究组(n=63),另选同期进行产前健康检查的孕妇作为对照组(n=55)。使用二维斑点追踪技术对两组患者胎儿的心功能进行检测,比较舒张末期的右心室面积(LVDA)、右心室周长(RVDC)、左心室周长(LVDC)及收缩末期的右心室面积(RVSA)、左心室面积(LVSA)、右心室周长(RVSC)、左心室周长(LVSC);比较胎儿三尖瓣流速(TV)、二尖瓣流速(MV)、左右心室舒张早期与晚期血流速度(E峰值流速、A峰值流速)及其比值(E/A)、左心室收缩分数1(LVSF1)左心室收缩分数2(LVSF2)、右心室收缩分数1(RVSF1)、右心室收缩分数2(RVSF1),比较胎儿心脏结构异常情况。 结果 研究组患者胎儿收缩末期的LVSA、RVSA、RVSC、LVSC均高于对照组(P < 0.05),而舒张末期的LVDA、RVDA、RVDC、LVDC均高于对照组(P < 0.05);研究组患者胎儿舒张期的心功能指标MVA、MVE、MV-E/A、TVA、TVE、TV-E/A均高于对照组(P < 0.05),而收缩末期的心功能指标LVSF1、RVSF1、LVSF2、RVSF2也均高于对照组(P < 0.05);研究组患者胎儿出现9例(14.29%)心脏结构异常,总发生率高于对照组(P < 0.05)。 结论 妊娠期甲状腺功能亢进患者胎儿心功能异常,心脏结构也可能存在异常,二维斑点追踪技术可在早期对胎儿的心功能及结构进行准确监测。 Abstract:Objective To explore the application of two-dimensional speckle tracking technique in assessing the fetal cardiac function in patients with thyroid dysfunction during pregnancy. Methods Sixty-three pregnant women with hyperthyroidism and another 55 healthy pregnant women underwent prenatal examination in our hospital from August 2021 to June 2022 were enrolled as study group and control group, respectively. Two-dimensional speckle tracking technology was used to detect fetal cardiac function. Comparison was conducted on parameters including right ventricular end-diastolic area (RVDA), left ventricular end-diastolic area (LVDA), right ventricular end-diastolic circumference (RVDC), left ventricular end-diastolic circumference (LVDC), right ventricular end-systolic area (RVSA), left ventricular end-systolic area (LVSA), right ventricular end-systolic circumference (RVSC), left ventricular end-systolic circumference (LVSC), tricuspid valve velocity (TV), mitral valve velocity (MV), peak E-wave velocity, peak A-wave velocity, E/A ratio, left ventricular shortening fraction 1 (LVSF1), left ventricular shortening fraction 2 (LVSF2), right ventricular systolic fraction 1 (RVSF1), right ventricular systolic fraction 2 (RVSF1). The fetal cardiac structures were observed, such as ventricular septal defect, tetralogy of Fallot, pulmonary stenosis, endocardial cushion defects, coarctation of aorta and tricuspid atresia. Results The differences of age, gestational weeks, BMI, systolic blood pressure, diastolic blood pressure and other clinical data between two groups were not significant (P > 0.05). LVSA, RVSA, RVSC and LVSC at end-systolic stage in study group were significantly higher than those in control group (P < 0.05), while LVDA, RVDA, RVDC and LVDC at end-diastolic stage were significantly higher than those in control group (P < 0.05). The fetal diastolic cardiac function indexes MVA, MVE, MV-E/A, TVA, TVE and TV-E/A in study group were significantly higher than those in control group (P < 0.05), and the end-systolic cardiac function indexes LVSF1, RVSF1, LVSF2 and RVSF2 were also higher than those in control group (P < 0.05). There were 9 cases (14.29%) of fetal cardiac structural abnormalities in study group, and the total incidence rate was significantly higher than that in control group (P < 0.05). Conclusion Fetal cardiac function is abnormal in patients with thyroid dysfunction during pregnancy, and cardiac structure may also be abnormal. Two- dimensional speckle tracking technology can accurately monitor fetal cardiac function and structure in the early stage. -
Key words:
- two-dimensional /
- speckle tracking imaging technique /
- pregnancy /
- thyroid function /
- cardiac function
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表 1 两组研究对象临床特征资料比较
Table 1. Comparison of the clinical characteristics of the study subjects between the two groups (Mean±SD)
组别 年龄(岁) 孕周(周) BMI(kg/m2) 收缩压(mmHg) 舒张压(mmHg) 研究组(n=63) 28.22±3.16 30.57±0.74 25.63±1.87 117.46±10.32 81.27±8.53 对照组(n=55) 27.94±3.27 31.23±0.85 25.48±1.65 115.52±10.64 78.39±9.02 t 0.4724 1.6688 0.4590 1.0041 1.1490 P 0.6375 0.0979 0.6471 0.3174 0.2529 表 2 两组患者胎儿心脏形态学比较
Table 2. Comparison of fetal cardiac morphology between the two patient groups (Mean±SD)
组别 收缩期 舒张期 LVSA(cm2) RVSA(cm2) RVSC(cm) LVSC(cm) LVDA(cm2) RVDA(cm2) RVDC(cm) LVDC(cm) 研究组(n=63) 2.83±0.20 3.37±0.31 6.73±0.79 6.65±0.61 4.07±0.35 4.25±0.34 8.63±1.21 7.94±1.03 对照组(n=55) 2.12±0.09 2.05±0.19 5.64±0.52 5.32±0.47 2.63±0.17 3.24±0.18 6.26±0.68 6.21±0.55 t 24.2605 27.3963 8.7140 13.1209 27.7753 19.7404 12.8570 11.1426 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 LVSA: 收缩末期左心室面积; RVSA: 收缩末期右心室面积; RVSC: 收缩末期右心室周长; LVSC: 收缩末期左心室周长; LVDA: 舒张末期左心室面积; RVDA: 舒张末期右心室面积; RVDC: 舒张末期右心室周长; LVDC: 舒张末期左心室周长. 表 3 两组患者胎儿舒张期心功能指标比较
Table 3. Comparison of fetal diastolic cardiac function indicators in the two groups (Mean±SD)
组别 MVA(cm/s) MVE(cm/s) MV-E/A TVA(cm/s) TVE(cm/s) TV-E/A 研究组(n=63) 56.22±6.34 58.45±7.03 2.89±0.15 55.68±6.51 60.12±8.79 1.46±0.32 对照组(n=55) 49.87±5.76 42.54±5.21 0.88±0.05 50.02±5.31 45.05±6.04 0.82±0.07 t 5.6624 13.7964 94.8397 5.1277 10.6971 14.5247 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 TV: 三尖瓣流速; MV: 二尖瓣流速; E/A: 舒张早期峰值流速/舒张晚期峰值流速. 表 4 两组患者胎儿收缩期心功能指标比较
Table 4. Comparison of fetal systolic cardiac function indicators in the two groups (Mean±SD)
组别 LVSF1 RVSF1 LVSF2 RVSF2 研究组(n=63) 0.23±0.03 0.19±0.02 0.33±0.06 0.36±0.07 对照组(n=55) 0.10±0.01 0.14±0.01 0.24±0.03 0.21±0.02 t 30.6695 16.7921 10.0753 15.3470 P < 0.001 < 0.001 < 0.001 < 0.001 LVSF1: 左心室收缩分数1; LVSF2: 左心室收缩分数2; RVSF1: 右心室收缩分数1; RVSF2: 右心室收缩分数2. 表 5 两组患者胎儿心脏结构异常情况比较
Table 5. Comparison of fetal cardiac structural abnormalities in the two groups [n(%)]
组别 室间隔缺损 心内膜垫缺损 肺动脉狭窄 主动脉弓缩窄 法洛四联症 三尖瓣闭锁 总发生率 研究组(n=63) 2(3.17) 2(3.17) 1(1.59) 1(1.59) 1(1.59) 2(3.17) 9(14.29) 对照组(n=55) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 0(0.00) χ2 8.5059 P 0.0035 -
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