脐带附着方式及双胎间胎膜皱褶在双胎输血综合征早期预测中的作用  

Study on Umbilical Cord Insertion and Inter-Twin Membrane Folding in the Early Prediction of Twin to Twin Transfusion Syndrome

作　　者：耿力[1] 杨丽娜[1] 唐丹[1] 胡顺琴[1] 刘军[1] 

机构地区：[1]昆明医科大学第一附属医院,云南昆明650032

出　　处：《实用妇产科杂志》2016年第9期694-697,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探索脐带附着方式及双胎间胎膜皱褶在双胎输血综合征（TTTS）发生中的预测价值。方法：选择2011年1月至2015年1月在昆明医科大学第一附属医院妇产科行产前检查并最后确诊的单绒毛膜双羊膜囊（MCDA）双胎的孕妇136例为研究对象,患者均接受产前超声检查,且被追踪到妊娠结局,其中TTTS组20例,非TTTS组116例。分析两组患者的彩色频谱多普勒超声检测脐带的附着方式及双胎间胎膜皱褶（孕15-17周）情况。结果：TTTS组脐带附着不一致发生率25.0%（5/20）高于非TTTS组8.6%（10/116）,差异有统计学意义（P〈0.05）;脐带附着不一致者发生TTTS的风险高于脐带附着一致者（OR 3.553,95%CI 1.062-11.754）。脐带附着不一致预测TTTS的敏感性、特异性、阳性预测值和阴性预测值分别为25.0%、91.4%、33.3%及87.6%。TTTS组和非TTTS组双胎间胎膜皱褶发生率分别为25.0%（5/20）和16.4%（19/116）,差异无统计学意义（P〉0.05）。结论：在MCDA双胎中,一胎儿中央附着,另一胎儿为边缘附着或帆状附着的,脐带附着不一致是TTTS发生的危险因素,脐带附着不一致预测TTTS的特异性及阴性预测值较高;双胎间胎膜皱褶未显示出对TTTS的预测价值。Objective：To explore the predictive value of umbilical cord insertion and inter-twin membrane folding for twin to twin transfusion syndrome（TTTS）. Methods： From January 2011 to January 2015,136 patients of monochorionic diamniotic（MCDA） were enrolled in department of obstetrics,the first affiliated hospital of Kunming Medical University. 20 patients with T＇ITS were marked as the -TTTS group, while the other 116 patients with non-TTTS as the non-TTTS group. Umbilical cord insertion and inter-twin membrane folding were detected by color spectrum Doppler ultrasound. Results：The incidence rate of inconformity of umbilical cord insertion in TTTS group and non-fTTS group was 25.0% （5/20） and 8.6% （ 10/116）, respectively. The incidence rate of incon- formity of umbilical cord insertion in TTTS group was significantly higher than tin non-TTTS group（ P 〈 0.05）. Patients with inconformity of umbilical cord insertion had higher risk of TTTS compared to those with consistency of umbilical cord insertion（ OR 3. 553,95% CI 1. 062 -11. 754）. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value（NPV） of inconformity of umbilical cord insertion in predicting TTTS was 25.0%,91.4%, 33.3% and 87.6%. The incidence rate of inter-twin membrane folding in TTTS group and non-TTTS group was 25.0% （5/20） and 16.4% （ 19/116）, respectively. There was no significant difference in the incidence rate of inter-twin membrane folding between TTTS group and non-TTTS group（ P 〉 0.05）. Conclu- sions：The inconformity of umbilical cord insertion may be a risk factor for TTTS. The inconformity of umbilical cord insertion has higher specificity and NPV,and inter-twin membrane folding may have no value in early predic- tion of TTTS.

关 键 词：脐带附着方式 双胎间胎膜皱褶 双胎输血综合征 

分 类 号：R714.53[医药卫生—妇产科学]