胎儿心脏定量分析技术评价妊娠期肝内胆汁淤积症孕妇胎儿心室收缩功能

Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis

摘要:

目的 探讨妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）对胎儿心室收缩功能的影响，为临床早期发现ICP胎儿心功能异常提供依据。方法 选取2022年7月至2023年4月于川北医学院附属医院就诊孕妇67例，孕周27~40周，其中ICP孕妇29例（ICP组），正常孕妇38例（对照组）。应用胎儿心脏定量分析（fetal heart quantification，Fetal HQ）软件测量胎儿心室收缩功能，包括纵向收缩功能：左、右心室整体纵向应变（global strain，GLS）、间隔壁应变（sept wall strain，SWS）、侧壁应变（free wall strain，FWS）；横向收缩功能：左、右心室24节段短轴缩短率（fractional shortening，FS）；整体收缩功能：左、右心室面积变化分数（fetal area change，FAC）、左心室射血分数（ejection fraction，EF）。结果 ICP组纵向收缩功能指标左、右心室GLS、SWS、FWS均低于对照组，差异有统计学意义（P<0.05）；两组间横向收缩功能指标左、右心室24节段FS比较，差异均无统计学意义（P>0.05）；ICP组整体收缩功能指标左、右心室FAC均低于对照组，差异有统计学意义（P<0.05），而两组间左心室EF比较，差异无统计学意义（P>0.05）。结论 在宫内高胆汁酸环境下，ICP胎儿心脏左、右心室整体及纵向收缩功能明显受损，横向收缩功能未见明显改变；并且与传统心脏功能评价指标左心室EF相比，FAC可以更加敏感地反映胎儿心脏整体功能的改变。

Abstract:

Objective To investigate the influence of intrahepatic cholestasis of pregnancy（ICP） on fetal ventricular systolic function，and to provide a basis for the early identification of fetal cardiac dysfunction in ICP.Methods A total of 67 pregnant women at 27-40 weeks of pregnancy who attended Affiliated Hospital of North Sichuan Medical College from July 2022 to April 2023 were enrolled，among whom there were 29 women with ICP（ICP group） and 38 normal pregnant women（control group）. Quantitative fetal heart analysis software was used to measure fetal ventricular systolic function，including longitudinal systolic function（global longitudinal strain ［GLS］，septal wall strain［SWS］，and free wall strain［FWS］ of the left and right ventricles），traverse systolic function（24-segment fractional shortening［FS］ of the left and right ventricles），and global systolic function（fetal area change［FAC］ of the left and right ventricles and ejection fraction［EF］ of the left ventricle）.Results As for longitudinal systolic function，the ICP group had significantly lower GLS，SWS，and FWS of the left and right ventricles than the control group（P<0.05）. As for traverse systolic function，there was no significant difference in the 24-segment FS of the left and right ventricles between the two groups（P>0.05）. As for global systolic function，the ICP group had significantly lower FAC of the left and right ventricles than the control group（P>0.05），while there was no significant difference in EF of the left ventricule between the two groups（P>0.05）.Conclusion In the intrauterine environment with high bile acid，the global systolic function and longitudinal systolic function of the left and right ventricles are significantly impaired in the fetus of women with ICP，and there is no significant change in traverse systolic function. Compared with EF of the left ventricule as the traditional indicator for evaluating cardiac function，FAC can be a more sensitive indicator in reflecting the changes of fetal heart function.