双胎输血综合征胎儿镜激光凝固胎盘吻合血管术后存活儿12月龄时神经系统预后分析  

Neurodevelopmental outcomes in twin-to-twin transfusion syndrome survivors at 12 months old after fetoscopic laser occlusion of chorioangiopagous vessels

作　　者：程春花[1] 李根霞[1] 楚书慧 尹盼 龚欢[2] 杜开先[2] 崔世红[1] Cheng Chunhua;Li Genxia;Chu Shuhui;Yin Pan;Gong Huan;Du Kaixian;Cui Shihong(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University(Advanced Medical Research Center of Zhengzhou University),Zhengzhou 450052,China;Department of Pediatrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科(郑州大学先进医学研究中心),郑州450052 [2]郑州大学第三附属医院儿内科,郑州450052

出　　处：《中华围产医学杂志》2022年第9期683-688,共6页Chinese Journal of Perinatal Medicine

基　　金：河南省医学科技攻关计划联合共建项目(2018020216)。

摘　　要：目的探讨影响双胎输血综合征(twin-to-twin transfusion syndrome,TTTS)胎儿镜激光凝固胎盘吻合血管(fetoscopic laser occlusion of chorioangiopagous vessels,FLOC)术后活产儿脑损伤的影响因素及在纠正12月龄时的神经系统发育。方法回顾性选取2018年5月至2021年8月在郑州大学第三附属医院行FLOC术的TTTS患者的136例胎儿作为FLOC组,并对存活儿进行随访。在纠正12月龄时应用Griffith精神发育评估量表-中文版(the Griffiths mental Development Scales-Chinese,GDS-C)从运动、个人-社会、听力语言、手眼协调、表现等5个领域进行评估。同时选取期待治疗和羊水减量术TTTS患者的88例胎儿作为非FLOC组。比较2组间围产儿死亡率及脑损伤发生率等,以及FLOC组中采用Solomon术与选择性激光术者脑损伤发生率。采用广义估计方程分析FLOC术后新生儿脑损伤影响因素及纠正12月龄时GDS-C量表总商评分的影响因素。采用χ^(2)检验、t检验和Mann-WhitneyU检验等进行统计学分析。结果(1)FLOC组围产儿死亡率低于非FLOC组[14.7%(20/136)与26.1%(23/88),χ^(2)=4.50,P=0.034];2组新生儿脑损伤发生率比较差异无统计学意义[18.7%(23/123)与21.8%(17/78),χ^(2)=0.29,P=0.592],但FLOC组重度脑损伤发生率低于非FLOC组[6.5%(8/123)与15.4%(12/78),χ^(2)=4.20,P=0.040]。(2)FLOC组中,供血儿与受血儿、Solomon术与选择性激光手术的脑损伤发生率比较,差异均无统计学意义[分别为16.4%(10/61)与21.0%(13/62)、20.0%(9/45)与17.9%(14/78),χ^(2)值分别为0.42和0.08,P值均>0.05]。(3)多因素分析显示,新生儿窒息(OR=7.04,95%CI:1.45~34.20,P=0.016)和术前TTTS分期(OR=2.05,95%CI:1.10~3.82,P=0.023)是发生新生儿脑损伤的危险因素。(4)纠正12月龄时随访成功52例,至少一项领域出现迟缓的发生率为34.6%(18/52)。发育迟缓主要表现在运动和语言领域,分别为26.9%(14/52)和11.5%(6/52);受血儿和供血儿各领域Z值比较差异均无统计学意义(P值Objective To investigate the risk factors for cerebral injury in survivors of twin-to-twin transfusion syndrome(TTTS)after fetoscopic laser occlusion of chorioangiopagous vessels(FLOC)and to analyze the neurodevelopmental outcomes at 12 months of corrected age.Methods A total of 136 cases of TTTS receiving FLOC in the Third Affiliated Hospital of Zhengzhou University from May 2018 to August 2021 were retrospectively selected as the FLOC group,and the survivors were followed up.Neurological development at 12 months of corrected age was assessed using the Griffiths mental development scales-Chinese(GDS-C)from five dimensions with locomotor,personal-social,hearing and language,hand-eye coordination and performance subscales.Eighty-eight fetuses of TTTS pregnancies receiving expectant treatment or amniotic fluid reduction were selected as the non-FLOC group.The perinatal mortality and the incidence of cerebral injury in the two groups were compared,as well as the incidence of cerebral injury between patients undergoing Solomon surgery and selective laser surgery in the FLOC group.Generalized estimating equations were used to analyze the risk factors for neonatal cerebral injury after FLOC and the factors influencing general developmental quotient score at the corrected age of 12 months.Chi-square test,t-test,and Mann-Whitney U test were used for statistical analysis.Results(1)The perinatal mortality rate in the FLOC group was lower than that in the non-FLOC group[14.7%(20/136)vs 26.1%(23/88),χ^(2)=4.50,P=0.034].There was no statistical significance in the incidence of neonatal cerebral injury between the two groups[18.7%(23/123)vs 21.8%(17/78),χ^(2)=0.29,P=0.592],but the incidence of severe cerebral injury in the FLOC group was lower than that in the non-FLOC group[6.5%(8/123)vs 15.4%(12/78),χ^(2)=4.20,P=0.040].(2)In the FLOC group,there was no significant difference in the incidence of cerebral injury between donors and recipients,or between Solomon surgery and selective laser surgery[16.4%(10/61)vs 21.0%(13/62),

关 键 词：双胎输血综合征 胎儿镜检查 激光凝固术 动静脉吻合 胎盘 神经心理学测验 神经发育障碍 

分 类 号：R714.5[医药卫生—妇产科学]