目的 分析心脏听诊、血氧饱和度(POX)检测联合吸氧情况在广西新生儿先天性心脏病(CHD)筛查中的准确性和可行性,为进一步推广此筛查方法提供依据。方法 选取2021年1月1日—12月31日在广西助产机构出生的活产新生儿作为研究对象,分别进行心脏杂音听诊和POX测定,并结合出生后吸氧情况进行综合筛查评估。任一项筛查指标阳性的新生儿即为CHD筛查阳性,所有筛查阳性新生儿均进行超声心动图诊断。根据筛查结果,分别计算各项筛查指标和多项指标联合筛查的灵敏度、特异度、阳性/阴性预测值、阳性/阴性似然比、约登指数等,并进行比较,评估CHD筛查方法的准确性。结果 共对469 261例新生儿进行筛查,共筛查阳性5 199例,确诊3 459例。多因素分析显示,心脏杂音(OR=620.17,95%CI:564.18~681.72)、异常POX结果(OR=235.52,95%CI:214.59~258.49)、吸氧≥72h(OR=333.45,95%CI:293.76~378.50)均是预测发生CHD的独立危险因素(P<0.05)。杂音组、血氧组、吸氧组检出CHD的灵敏度分别为53.34%(51.66%～55.01%)、34.32%(32.74%～35.93%)、22.23%(20.86%～23.66%);杂音联合POX筛查的灵敏度为79.73%(78.35%～81.05%),加入吸氧指标后检出CHD的灵敏度可提高至91.73%(90.75%～92.62%),ROC曲线下面积为0.96(95%CI:0.95～0.96)。结论 心脏听诊和POX联合吸氧情况筛查具有无创、简易、可靠的特点,能够及时在新生儿早期发现CHD,值得推广应用。
Abstract
Objective To analyze the accuracy and feasibility of combining cardiac auscultation, pulse oximetry (POX) screening, and oxygen therapy assessment for congenital heart disease (CHD) detection in newborns in Guangxi, China, in order to provide basis for wider implementation of this screening strategy. Methods Live newborns delivered in obstetric institutions in Guangxi between January 1st and December 31st, 2021, were enrolled. Cardiac auscultation and POX screening were performed respectively, and the screening results were evaluated in combination with oxygen inhalation. Neonates positive on any screening parameter were classified as CHD screen-positive and further diagnosed by echocardiography. Sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios, and Youden's index were calculated for individual and combined screening measures, and comparisons were made to assess the accuracy of the CHD screening method. Results A total of 469 261 neonates were screened, with 5 199 identified as positive, among whom 3 459 were confirmed cases of CHD. Multivariate analysis revealed that cardiac murmurs (OR=620.17, 95%CI: 564.18 - 681.72), abnormal POX results (OR=235.52, 95%CI: 214.59 - 258.49), and oxygen therapy for ≥72 hours (OR=333.45, 95%CI: 293.76 - 378.50) were independent risk factors for predicting CHD (P＜0.05). The sensitivities for detecting CHD in the murmur group, POX group, and oxygen therapy group were 53.34% (95%CI: 51.66% - 55.01%), 34.32% (95%CI: 32.74% - 35.93%), and 22.23% (95%CI: 20.86% - 23.66%), respectively. The sensitivity rose to 79.73% (95%CI: 78.35% - 81.05%) when combining cardiac auscultation with POX, and further increased to 91.73% (95%CI: 90.75% - 92.62%) upon incorporating oxygen therapy indicators, with the area under the ROC curve reaching 0.96 (95%CI: 0.95% - 0.96%). Conclusions The combination of cardiac auscultation, POX screening, and assessment of oxygen therapy requirements is non-invasive, simple, and reliable, effectively facilitating early detection of CHD in newborns. These findings support the broader application and promotion of this screening approach.
关键词
新生儿 /
先天性心脏病 /
筛查 /
心脏听诊 /
经皮血氧饱和度
Key words
neonates /
congenital heart disease /
screening /
cardiac auscultation /
pulse oximetry
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基金
广西壮族自治区卫生健康委西医类自筹经费科研课题(Z-A20220327)
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