早孕期心率联合颈项透明层厚度差异对双胎输血综合征的预测价值  

The Predictive Value of Difference in Heart Rate Combined with Nuchal Translucency Thickness in Early Pregnancy for Twin-twin Transfusion Syndrome

作　　者：关朕 耿丹明[1] 陈桑[1] 吴琳琅[1] 林玲 Guan Zhen;Geng Danming;Chen Sang;Wu Linlang;Lin Ling Fuzong(Clinical Medical College of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学福总临床医学院,福州市350025

出　　处：《中国超声医学杂志》2022年第5期543-546,共4页Chinese Journal of Ultrasound in Medicine

基　　金：福建省科技计划重点项目(No.2014Y5009);军民融合临床研究专项(No.2018J12)。

摘　　要：目的 应用胎儿超声心动图,探讨早孕期利用单绒毛膜双羊膜囊(MCDA)双胎心率(FHR)差值预测双胎输血综合征(TTTS)的可行性,并探讨联合检测FHR差异和颈项透明层(NT)厚度差异预测TTTS的优势。方法 以95例MCDA双胎为研究对象进行回顾性分析,共收集TTTS病例组11例,对照组84例。采用ROC曲线分析早孕期两组双胎的NT差值、心率差值与TTTS发生的相关性,并通过比较灵敏度、特异度、阳性预测值、阴性预测值评估联合检测相较于单项检测是否存在优势。结果 病例组双胎NT差值和心率差值的中位数(分别为0.6 mm、12次/min)均高于对照组(分别为0.2 mm、5次/min),最优界值分别为0.5 mm、8次/min。二者联合检测预测TTTS的灵敏度、阳性预测值、阴性预测值分别为90.91%、43.47%、98.61%,均优于单项检测(P<0.05)。结论 MCDA双胎早孕期NT差异和胎心率差异对TTTS均有预测作用,且采用两项联合检测,较单项检测有更高的预测价值。Objective Fetal echocardiography was used to investigate the feasibility of using fetal heart rate(FHR) difference of monochorionic diamniotic(MCDA) twins to predict twin-twin transfusion syndrome(TTTS) in early pregnancy, and to explore the superiority of combining FHR difference and NT thickness difference to predict TTTS. Methods A retrospective analysis was conducted on 95 MCDA twins, including 11 cases in TTTS case group and 84 cases in control group. ROC curve was used to analyze the correlation between NT difference, heart rate difference and the occurrence of TTTS between the two groups in early pregnancy. The sensitivity, specificity, positive predictive value and negative predictive value were compared to evaluate the advantages of combined detection over single detection. Results The median values of NT difference and heart rate difference of twins in the case group(0.6 mm and 12 beats/min respectively) were higher than those in the control group(0.2 mm and 5 beats/min respectively). The optimal threshold values were 0.5 mm and 8 beats/min. The sensitivity, positive predictive value and negative predictive value of the combined detection were 90.91%, 43.47% and 98.61%, which were more advantageous than single detection(P<0.05). Conclusions Both NT difference and fetal heart rate difference of MCDA in the early pregnancy can predict TTTS, and the combined detection has greater predictive value than the single detection.

关 键 词：双胎输血综合征 颈项透明层 胎心率 产前超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]