摘要目的:分析早孕期和中孕早期正常胎儿左、右心室各径线与胎儿生物学生长参数的关系，拟建立不同孕周左、右心室各径线的参考值及Z-评分模型。方法:选取2019年2－5月浙江大学医学院附属邵逸夫医院246例早孕期(11 ～13 ＋6周)和中孕早期(14 ～17 ＋6周)正常胎儿，获得胎儿头臀径(CRL)、双顶径(BPD)、股骨径(FL)、孕周(GA)等生物学生长参数。通过胎儿超声心动图标准四腔心切面测量舒张末期左、右心室横径(LVW、RVW)、长径(LVL、RVL)，计算左、右心室横径与长径之积的舒张期面积(LVA、RVA)，左、右心室长径与横径之比的球形指数(LVSI、RVSI)，左、右心室横径之比(LVW/RVW)、长径之比(LVL/RVL)、面积之比(LVA/RVA)。以GA、BPD及FL作为自变量，以上述预测的心室内径及其派生值参数为因变量，建立最佳模型，分析各标准差(SD)与自变量之间的相关性，根据以上统计数据，应用公式，计算左、右心室各径线相应的Z-评分。 结果:①LVW、RVW、LVL、RVL随GA、BPD和FL的增加而增长，呈显著正相关，其中以GA与LVW、RVW的相关性最好( r＝0.928、0.930，均 P<0.000 1)。②以GA为例，LVA、RVA与GA呈正相关( r＝0.868、0.872，均 P<0.000 1)；球形指数LVSI、RVSI与GA呈负相关( r＝－0.844、－0.861，均 P<0.000 1)，且LVSI>RVSI；LVW/RVW<1且几乎接近于1，其比值与GA呈负相关( r＝－0.147， P<0.000 1)；LVL/RVL>1，比值与GA呈正相关( r＝0.313， P<0.000 1)；LVA/RVA>1，与GA之间未见明显相关性。③LVW、RVW等的标准差(SD)随自变量GA、BPD和FL增大而增大，以GA与LVW为例，LVW的直线回归方程： Y＝－5.338＋0.549GA( r＝0.928， P<0.000 1)，LVW-SD直线回归方程： Y＝－0.322＋0.037GA( r＝0.131， P<0.000 1)。LVW、RVW、LVL、RVL、LVA、RVA的Z-评分值随GA、BPD、FL的增长相对恒定。 结论:使用统计方法建立早孕期及中孕早期正常胎儿左、右心室内径的参考值及其Z-评分简单易行，在更早、更精准的定量化评估和分析此阶段胎儿心脏的发育情况方面具有潜在应用价值。

abstractsObjective:To investigate the association of left and right ventricular diameters in normal early pregnancy and early middle pregnancy to the biological growth parameters of fetus, and to establish the reference and Z-score model for left and right ventricles.Methods:Two hundred and forty-six fetuses in normal early pregnancy (11-13 + 6 weeks) and early middle pregnancy (14-17 + 6 weeks) from February 2019 to May 2019 in Sir Run Run Shaw Hospital were examined by routine ultrasound. Non-cardiac fetal biometric parameters included crown-rump length (CRL), biparietal diameter (BPD) and femoral length (FL) and gestation age (GA) based on menstrual age were assessed. The left and right ventricular widths (LVW, RVW) and ventricular lengths (LVL, RVL) were measured at the end of diastolic period by obtaining the standard four chamber view of fetal echocardiography. The end-diastolic areas (LVA, RVA) as the products of the ventricular widths and lengths, the global spherical indexes (GSI) of left and right ventricles (LVSI, RVSI), the ratios of left and right ventricular widths (LVW/RVW), the length ratios (LVL/RVL) and the area ratios (LVA/RVA) of both ventricles were calculated.GA, BPD and FL were used as independent variables. The predicted cardiac parameters and its derivative parameters were used as dependent variables. The corresponding reference range was established. The correlation between each standard deviation (SD) and independent variables was analyzed, and the corresponding Z-scores of left and right ventricular diameters were calculated by using the formula. Results:①LVW, RVW, LVL, RVL were found positively correlated with the increase of GA, BPD and FL, and the correlation between GA and LVW, RVW was the highest ( r=0.928, 0.930; all P<0.000 1). ②There was a positive correlation between LVA, RVA and GA ( r=0.868, 0.872; all P<0.000 1). LVSI, RVSI were found negatively correlated with GA ( r=-0.844, -0.861; all P<0.000 1), and LVSI>RVSI. LVW/RVW<1 and almost close to 1, the ratios decreased with the increase of GA( r=0.147, P<0.000 1). LVL/RVL>1, the ratios increased with the increase of GA( r=0.313, P<0.000 1). LVA/RVA>1, but there was no correlation with GA. ③The SD values of LVW, RVW, LVL, RVL positively correlated with independent variables. Taking GA and LVW as an example, the linear regression equation of LVW was Y=-5.338+ 0.549GA ( r=0.928, P<0.000 1), and the linear regression equation of LVW-SD was Y=-0.322+ 0.037GA( r=0.131, P<0.000 1). The Z-scores of LVW, RVW, LVL, RVL, LVA, RVA did not change with the changes of GA, BPD, and FL. Conclusions:The normal reference range and Z-scores of left and right ventricular lengths and widths can be simply and reliably established using statistical analysis, and these parameters might have potentials for more accurately and more early evaluating the normal development of fetal heart.