胎儿镜治疗双胎输血综合征术后胎儿结局的预测因素分析及预测模型的构建  

Fetal outcome of the treatment for twin-to-twin transfusion syndrome with fetoscope:analysis of predicting factors and construction of predicting model

作　　者：尚尉 尹少尉[1] 刘彩霞[1] 侯佳汝 SHANG Wei;YIN Shao-wei;LIU Cai-xia;HOU Jia-ru(Department of Obstetrics and Gynecology,Shengjing Hospital Affliated to China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院妇产科中国医科大学出生队列中心,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2021年第12期1237-1241,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2018YFC1002902,2018YFC1002900)。

摘　　要：目的探讨胎儿镜治疗双胎输血综合征(twin to twin transfusion syndrome,TTTS)术后胎儿结局的预测因素,并构建预测模型。方法选取2019年1月至2021年9月于中国医科大学附属盛京医院接受胎儿镜激光手术(fetoscopic laser surgery,FLS)治疗的77例TTTS孕产妇进行回顾性分析,FLS手术孕周均在16~26周。77例孕产妇通过胎儿结局分为双胎死亡组24例以及至少一胎存活组53例,对两组孕产妇的临床资料、超声特点以及FLS术中情况进行单因素分析,将差异具有统计学意义的各项指标纳入多因素logistics回归模型进行分析,明确影响术后胎儿结局的预测因素,并应用受试者工作特征(receiver operating characteristic,ROC)曲线评价所建立模型的预测价值。结果(1)经单因素分析显示:母体年龄、手术孕周、胎盘的位置等对胎儿存活率无明显统计学意义(P>0.05),而发病到手术时间、术前子宫颈状态、术前宫缩情况、Quintero分期、受血儿(Recepient)大脑中动脉MOM值、供血儿(Donor)大脑中动脉MOM值、羊水减量速率(mL/min)有统计学意义。(2)logistic多因素回归分析显示:发病到手术时间、术前子宫颈状态、术前宫缩情况、Quintero分期、Recepient大脑中动脉MOM值、Donor大脑中动脉MOM值、羊水减量速率(mL/min)均为影响术后胎儿结局的关键因素(P<0.05)。(3)根据筛选出的影响因素构建的预测模型经ROC曲线评价准确率较高。结论FLS治疗的TTTS孕产妇术后胎儿结局与多种因素有关,可根据影响因素初步筛选胎儿镜术后发生不良预后的高危产妇并对其进行早期干预,这对增加TTTS术后的胎儿存活率具有重要意义。Objective To explore the factors affecting the fetal outcomes of twin-to-twin transfusion syndrome(TTTS)by fetoscopic laser surgery(FLS)and the establishment of predictive model.Methods This study is a retrospective study.Seventy-seven FLS-treated TTTS patients admitted to Shengjing Hospital affiliated to China Medical University from January 2019 to September 2021 were retrospectively analyzed.Gestational weeks of FLS were 16-26 weeks.According to the pregnancy outcome,77 patients were divided into a twin death group with 24 cases and a group with at least one surviving with 53 cases.The clinical data of the two groups of pregnant women with TTTS,the ultrasound characteristics and the fetal endoscopy were analyzed by univariate analysis,and the indicators with significant statistical differences were incorporated into the multiple linear regression model for multivariate analysis to make clear the predicting factors that influence the postoperative fetal outcome,and receiver operating characteristic curve was used to evaluate the predictive value of the established model.Results(1)The univariate analysis showed that:maternal age,gestational age,placenta position,etc.had no significant statistical significance on the fetal survival rate(P>0.05).However the time from onset to operation,preoperative cervical status,preoperative uterine contractions,Quintero staging,the MOM value of the middle cerebral artery in the recipient,the MOM value of the middle cerebral artery in the donor,and the rate of amniotic fluid reduction(mL/min)were statistically significant.(2)Logistic multivariate regression analysis showed that the time from onset to operation,preoperative cervical state,preoperative uterine contractions,Quintero stage,the MOM value of middle cerebral artery of Recepient,the MOM of middle cerebral artery of Donor,and amniotic fluid reduction rate(mL/min)were the key factors affecting postoperative fetal outcome(P<0.05).(3)The prediction model constructed according to the screened influencing factors had high acc

关 键 词：双胎输血综合征 胎儿镜激光手术 胎儿结局 预测模型 ROC曲线 

分 类 号：R714.2[医药卫生—妇产科学]