基于孕早期胎儿超声软指标和代谢因素的先天性心脏畸形预测模型的构建分析

doi:10.3969/j.issn.1006-6233.2022.02.013

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Abstract Objective: To explore the value of the predictive model constructed by fetal ultrasound soft index and metabolic index in the prediction of congenital heart malformations. Methods: Totally 200 cases of pregnant women with high risk factors for CHD who received prenatal examinations in the Department of Obstetrics and Gynecology of our hospital from April 2018 to May 2020 were included. The urine of all pregnant women at the 11~13⁺⁶ weeks of pregnancy was collected during the obstetric examination, and liquid chromatography -Mass spectrometry (LC-MS) method was used to detect the levels of 4-hydroxyphenylacetic acid, acrylic acid, malonic acid and uric acid in urine; fetal echocardiography is used to check the thickness of fetal neck transparent layer (Nuchal translucency, NT) and cardiac tricuspid regurgitation Abnormal flow and venous catheter blood flow. According to whether the fetus was diagnosed with CHD in the later follow-up, the pregnant women were divided into CHD group and control group; the clinical data of the two groups of pregnant women were compared, and the multivariate logistic regression equation was used to analyze the relevant factors affecting the fetal heart malform R software was used to build a nomogram prediction model based on the training set, and the effectiveness of the model was evaluated on the test set. Results: The urine levels of 4-hydroxyphenylacetic acid, acrylic acid, malonic acid, and uric acid of the observation group were higher than those of the control group, and the NT thickness, the proportion of tricuspid regurgitation, and the proportion of abnormal blood flow in the venous catheter were higher than those of the control group. The difference was statistically significant (P<0.05); Multivariate logistic regression analysis showed that urine levels of 4-hydroxyphenylacetic acid (OR=2.740), high acrylic acid levels (OR=3.242), high uric acid levels (OR=1.013) and NT values increased (OR=20.411) and tricuspid regurgitation (OR=9.028) are independent risk factors for fetal congenital heart malformations in the first trimester (P<0.05); by constructing a nomogram prediction model, the results show that the model predicts fetal CHD risk with the consistency index (C-index) 0.915. External verification showed that the sensitivity was 88.00%, the specificity was 96.36%, the accuracy rate was 93.75%, the positive predictive value was 91.67%, and the negative predictive value was 94.64%. Conclusion: Early pregnancy ultrasound examination of NT thickness, tricuspid regurgitation, and the levels of 4-hydroxyphenylacetic acid, acrylic acid and uric acid in the urine of pregnant women are related to the risk of fetal CHD. The prediction model based on ultrasound soft indicators and metabolic indicators has a good predictive performance for higher risk of fetal CHD.

Key words： Ultrasound index Metabolic index Congenital heart malformation Prediction model Early pregnancy

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	CHEN Congli
	QU Dongying

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CHEN Congli,QU Dongying. Construction of a Predictive Model for Congenital Heart Malformations Based on Fetal Ultrasound Soft Indicators and Metabolic Factors in the First Trimester[J]. HeBei Med, 2022, 28(2): 244-249.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.02.013 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I2/244

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