脑-胎盘率和分娩孕周预测双胎输血综合征围产结局的价值  

Predictive value of cerebroplacental ratio and gestational age at delivery for perinatal outcome in twin-twin transfusion syndrome

作　　者：张婷婷 张秀丽[1] 滑少华[1] 杨娟[1] ZHANG Ting-ting;ZHANG Xiu-li;HUA Shao-hua;YANG Juan(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,郑州450052

出　　处：《医药论坛杂志》2024年第20期2151-2156,共6页Journal of Medical Forum

基　　金：郑州市科技局协同创新专项项目(XTCX2023011)。

摘　　要：目的分析双胎输血综合征(twin-twin transfusion syndrome,TTTS)胎儿脑-胎盘血流参数和生物学指标差异在围产结局中的预测价值。方法回顾性分析2014年1月至2023年1月在郑州大学第一附属医院诊断的53例未行任何宫内治疗的TTTS,其中不良结局组30例,良好结局组23例。分析两组脐动脉搏动指数差异(discordance of umbilical arterial pulsatility index,UA-PIdisc)、大脑中动脉收缩期峰值流速MoM值差异(discordance of middle cerebral artery-peak systolic velocity of multiples of the median,MCA-PSV MoM_(disc))、大脑中动脉搏动指数差异(discordance of middle cerebral artery pulsatility index,MCA-PIdisc)、脑-胎盘率差异(discordance of cerebroplacental ratio,CPRdisc)、估测体重差异(estimated fetal weight,EFW_(disc))和诊断孕周、分娩孕周、Quintero分期的差异,采用单因素及多因素logistics回归分析识别围产儿丢失的危险因素,进而采用ROC曲线评估各指标预测不良围产结局的诊断效能。结果不良结局组TTTS诊断孕周[23.4(21.0~26.6)与30(28.2~31.0)]和分娩孕周[24.2(21.1~26.8)与30.4(29.5~32.4)]均较良好围产结局组早(P<0.05),且不良结局组Quintero分期[Ⅰ期13.3%(4/30)与56.5%(13/23)、Ⅱ期13.3%(4/30)与8.7%(2/23)、Ⅲ期36.7%(11/30)与21.7%(5/23)、Ⅳ期36.7%(11/30)与13.0%(3/23)]更重(P<0.05)。不良结局组供血儿UA-PI[1.34(1.09~2.12)与1.13(0.96~1.46)]、MCA-PSVMOM[1.10(0.87~1.29)与0.94(0.70~1.13)]较良好结局组高(P<0.05);不良结局组UA-PIdisc[38.42(17.90~55.47)与7.87(4.00~22.67)]、MCA-PIdisc[29.71(13.82~46.99)与16.58(7.69~28.06)]和CPRdisc[51.25(34.52~67.86)与16.28(5.63~34.86)]高于良好结局组(P<0.05)。多因素回归分析显示,CPRdisc(OR=1.072,95%CI 1.032~1.114)和分娩孕周(OR=0.445,95%CI 0.284~0.695)是TTTS围产儿丢失的危险因素(P<0.05)。ROC曲线显示,CPRdisc+分娩孕周两者结合预测不良围产结局的曲线下面积为0.965,敏感性为97%,特异性为87%(P<0.05)。结论不良结局组TTTSObjective To analyze the predictive value of the difference of cerebroplacental blood flow parameters and fetal biometry in perinatal outcomes in twin-twin transfusion syndrome(TTTS).Methods A retrospective study was conducted to study 53 cases of TTTS diagnosed at the First Affiliated Hospital of Zhengzhou University during January 2014 to January 2023,in which no intrauterine treatment was performed.Among them,23 cases had good outcomes,while 30 cases had adverse outcomes.The discordance of umbilical arterial pulsatility index(UA-PI_(disc)),the middle cerebral artery-peak systolic velocity of multiples of the median(MCA-PSV_(MoM disc)),middle cerebral artery pulsatility index(MCA-PI_(disc)),cerebroplacental ratio(CPR_(disc)),estimated fetal weight(EFW_(disc)),gestational ages at diagnosis,gestational ages at delivery,and Quintero staging between the two groups were analyzed.A logistic regression analysis was employed to identify and adjust for risk factors.The accuracy of prediction was evaluated through the analysis of the receiver-operating characteristic curve.Results The adverse outcome group had earlier gestational age at diagnosis[23.4(21.0-26.6)vs 30(28.2-31.0)]and gestational age at delivery[24.2(21.1-26.8)vs 30.4(29.5-32.4)]in TTTS than the good outcome group(P<0.05),and the Quintero stage[stageⅠ13.3%(4/30)vs 56.5%(13/23);stageⅡ13.3%(4/30)vs 8.7%(2/23);stageⅢ36.7%(11/30)vs 21.7%(5/23);stageⅣ36.7%(11/30)vs 13.0%(3/23)]was severe in the adverse outcome group(P<0.05).The adverse outcome group donor twins had higher UA-PI[1.34(1.09-2.12)vs 1.13(0.96-1.46)]and MCA-PSV_(MOM)values[1.10(0.87-1.29)vs 0.94(0.70-1.13)]than those in the good outcome group(P<0.05).Compared to the good outcome group,the difference values of UA-PI_(disc)[38.42(17.90-55.47)vs 7.87(4.00-22.67)],MCA-PI_(disc)[29.71(13.82-46.99)vs 16.58(7.69-28.06)],and CPR_(disc)[51.25(34.52-67.86)vs 16.28(5.63-34.86)]were higher than those in the adverse outcome group(P<0.05).Multivariable regression analyses showed that CPR_(disc)(OR=1.072,95

关 键 词：超声检查 双胎输血综合征 单绒毛膜双羊膜囊双胎 脑-胎盘率 分娩孕周 

分 类 号：R445.1[医药卫生—影像医学与核医学]