Quintero分期、CHOP分级与TTTS脑损伤的相关性对比分析  

Comparative analysis of the correlation between Quintero stage,CHOP grade and TTTS brain injury

作　　者：杨泽宇[1] 解丽梅 孟新月[1] 孙微[1] YANG Ze-yu;XIE Li-mei;MENG Xin-yue;SUN Wei(Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004;Department of Ultrasound,Roicare Hospital&Clinics,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004 [2]沈阳安联妇婴医院超声科,辽宁沈阳110000

出　　处：《中国临床医学影像杂志》2022年第5期350-353,共4页Journal of China Clinic Medical Imaging

基　　金：辽宁省自然科学基金项目(编号2019-BS-274);盛京医院345人才工程项目(编号M0703)。

摘　　要：目的:比较研究Quintero分期和CHOP分级与TTTS脑损伤相关性,以期提供预测TTTS神经系统预后的产前评估方案。方法:2012年1月—2021年12月在盛京医院参加双胎队列研究的单绒毛膜双胎,经随访证实为TTTS者共262例,按Quintero标准进行产前诊断和分期,同时进行胎儿超声心动图检查获得CHOP评分并进行分级,分析胎儿颅脑超声表现,分析并比较Quintero分期和CHOP分级与TTTS脑损伤相关性。结果:262例双胎参加了这项研究。发生脑损伤28例(10.7%),31例胎儿脑损伤,在超声图像上呈现脑出血、缺血缺氧性脑病、脑软化等改变。在脑损伤组中,Quintero分期与脑损伤无统计学上相关性,而CHOP分级在统计上与研究人群中的脑损伤相关。结论:Quintero分期和CHOP分级中,后者与TTTS脑损伤相关,CHOP评分可用于产前TTTS脑损伤风险评估,建议TTTS常规筛查及激光术前术后行胎儿心脏结构及功能评估,CHOP分级Ⅲ级及以上者,不考虑Quintero分期的因素,孕期需进行针对性的神经系统超声检查及新生儿期颅脑超声、MRI检查。Objective:To compare the correlation between Quintero stage,CHOP grade and TTTS brain injury,in order to provide a prenatal evaluation scheme for predicting the prognosis of TTTS nervous system.Methods:A total of 262 cases of MCDA twins who participated in the cohort study of twins in Shengjing Hospital from January 2012 to December 2021 were diagnosed and staged according to Quintero criteria.At the same time,fetal echocardiography was performed to obtain CHOP score.Fetal brain ultrasound findings were analyzed,and the correlation between Quintero stage,CHOP grade and TTTS brain injury were analyzed and compared.Results:262 twins participated in this study.Brain injury occurred in 28 cases(10.7%),and 31 cases of fetal brain injury showed changes such as cerebral hemorrhage,hypoxic-ischemic encephalopathy and encephalomalacia on ultrasound images.In the brain injury group,there was no statistical correlation between Quintero stage and brain injury,while CHOP grade was statistically related to brain injury in the study population.Conclusion:In Quintero staging and CHOP score,the latter is related to TTTS brain injury.CHOP grade can be used to assess the risk of prenatal TTTS brain injury.It is suggested that fetal heart structure and function assessment is necessary for TTTS routine screening and laser preoperative and postoperative monitoring,CHOP grade Ⅲ or above,do not consider the factors of Quintero staging,pertinent nervous system ultrasound examination and neonatal brain ultrasound and MRI examination should be performed during pregnancy.

关 键 词：双胎输血综合征 脑损伤 超声检查 产前 

分 类 号：R714.56[医药卫生—妇产科学] R445.1[医药卫生—临床医学]