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目的本研究旨在应用二维超声心动图测量并分析正常胎儿和主动脉弓缩窄(Co A)胎儿的心脏大血管径线Z-score值及其各自血管径线比值,探讨正常胎儿心脏血管径线Z-score数据模型和血管内径比值在胎儿Co A产前诊断中的价值。方法本研究正常组纳入800例正常胎儿,Co A组纳入50例Co A胎儿,利用二维超声声像图测量左心房内径(LAID)、左心室内径(LVID)、右心房内径(RAID)、右心室内径(RVID)、主肺动脉(MPA)内径、升主动脉(AAO)内径、主动脉弓峡部(AAI)内径、动脉导管(DA)内径、降主动脉(DAO)内径,计算正常组及病例组RAID/LAID,RVID/LVID,MPA/AAO,DA/AAI,DAO/AAI,AAO/AAI,AAO/DAO的比值。以孕周为自变量建立正常胎儿心脏大血管径线Z-score数据模型,计算Co A组9项指标的Z-score值并进行分析比较。结果1.Co A组RAID Z-Score、RVID Z-Score、MPA Z-Score、DA Z-Score的均数以及RAID/LAID、RVID/LVID、MPA/AAO、DA/AAI、DAO/AAI、AAO/AAI比值的均数大于正常值胎儿;Co A组LVID Z-Score、AAO Z-Score、AAI Z-Score的均数及AAO/DAO比值均数小于正常组胎儿(P<0.05)。2.散点图中显示Co A组AAO Z-Score、DA Z-Score、AAI Z-Score、MPA/AAO、DA/AAI、DAO/AAI及AAO/DAO比值与正常组明显分开分布,差异有统计学意义(P<0.05)。3.ROC曲线显示以下指标的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数、曲线下面积(AUC)、截断值,并按照诊断效能由高至低排序:AAI Z-Score(90%,94.9%,52.3%,99.3%,17.65,0.1,0.849,0.992,-2);DAO/AAI(100%,90.4%,39.4%,100%,10.41,0,0.904,0.996,1.7);DA/AAI(100%,89.3%,37%,100%,9.35,0,0.893.0.998,1.5);MPA/AAO(90%,89.8%,35.4%,99.3%,8.82,0.11,0.798,0.954,1.6);AAO Z-Score(98%,88.3%,34.3%,99.9%,8.38,0.02,0.863,0.992,-2);AAO/DAO(82%,89.3%,32.3%,98.8%,7.7,0.2,0.713,0.96,0.8)结论1.本研究建立的正常胎儿Z-score数据模型可作为胎儿超声心动图检查的参考依据。2.AAI Z-Score<-2、AAO Z-Score<-2和比值指标DA/AAI增大、DAO/AAI增大、MPA/AAO增大、AAO/DAO减小可作为产前超声预测Co A的依据。