双胎输血综合征早孕期超声预测指标初探

发布时间：2018-01-15 03:15

本文关键词：双胎输血综合征早孕期超声预测指标初探　出处：《实用妇产科杂志》2015年11期 　论文类型：期刊论文

【摘要】：目的:实施前瞻性研究探讨孕11~14周超声筛查单绒毛膜双胎颈项透明层厚度(nuchal translucency,NT)不一致及静脉导管(ductus venosus,DV)血流频谱异常预测双胎输血综合征(twintwin transfusion syndrome,TTTS)的有效性。方法:选择2011年1月至2013年12月在四川大学华西第二医院就诊,孕11~14周经超声筛查为单绒毛膜双胎孕妇。测量胎儿NT,以双胎儿NT差值0.6 mm为NT不一致;采集DV血流频谱,以一个胎儿出现A波倒置或消失为DV血流频谱异常。随访相关数据及胎儿结局。结果:孕11~14周超声筛查单绒毛膜双胎孕妇,最终纳入67例。胎儿中位顶臀长(CRL)66.00±0.96 mm,中位妊娠孕周为12周。产前超声诊断TTTS 13例(19.4%),均在孕16~28周诊断,产后或引产后证实。NT不一致19例,其中7例发展为TTTS,NT不一致筛查TTTS敏感性53.8%(95%CI 29.0~76.8),特异性77.8%(95%CI 65.1~86.8)。DV血流频谱异常16例,其中11例发展为TTTS(9例一胎DV血流频谱异常,2例双胎DV血流频谱均异常),且都合并NT不一致。双胎DV血流频谱异常联合NT不一致筛查TTTS敏感性84.6%(95%CI 57.8~95.7),特异性90.7%(95%CI 80.1~96.0)。结论:孕11~14周单绒毛膜双胎NT不一致及DV血流频谱异常可能是双胎儿血流动力学不平衡的早期表现,对于单绒毛膜双胎行NT检查时需要评估DV血流频谱状况,NT不一致联合DV血流频谱异常可能是预测TTTS的早期指标。
[Abstract]:Objective: to carry out a prospective study to investigate the thickness of cervical clear layer and nuchal translucency in patients with single chorionic twins by ultrasound screening at 1114 weeks of gestation. NT2) inconsistency and ductus venosus. DVV) abnormal blood flow spectrum was used to predict twintwin transfusion syndrome. Methods: from January 2011 to December 2013, we selected to visit the second West China Hospital of Sichuan University. At the 14th week of gestation, pregnant women with single chorionic twins were screened by ultrasound. The fetal NTs were measured and the NT difference between the two fetuses was 0.6 mm for NT inconsistency. DV blood flow spectrum was collected, A wave was inverted or disappeared as DV frequency spectrum abnormality in one fetus. The data of follow-up and fetal outcome were followed up. Results: single chorionic twin pregnancy was screened by ultrasound at 1114 weeks of gestation. 66.00 卤0.96mm, median gestational week was 12 weeks. TTTS was diagnosed by prenatal ultrasound in 13 cases (19.44mm). All of them were diagnosed at the 28th week of gestation. 19 cases were confirmed to be inconsistent after postpartum or induced labor, of which 7 cases developed into TTTS. The sensitivity of NT in screening TTTS was 53.8%, 95 CI 29.0 and 76.8). There were 16 cases with abnormal blood flow spectrum of CI 65.1 and 86.8%. Among them, 11 cases developed abnormal frequency spectrum of DV in one fetus of TTTS(9. In 2 cases, the blood flow spectrum of DV was abnormal. The sensitivity of TTTS screening was 84.6% and 95 CI 57.8 卤95.7). Specificity 90.7 ~ 95CI 80.1 ~ 96.0). Conclusion: NT inconsistency and abnormal blood flow spectrum of DV may be the early manifestation of hemodynamic imbalance in patients with single chorionic twins at 1114 weeks of gestation. In the case of single chorionic twins, it is necessary to evaluate the blood flow spectrum status of single chorionic twins. NT inconsistency and abnormal DV blood flow spectrum may be an early predictor of TTTS.
【作者单位】：四川大学华西第二医院超声科;
【基金】：四川省科技厅应用基础计划项目(编号:2011JY0020) 成都市科技局科技惠民技术研发项目(编号:2014-HM01-00049-SF)
【分类号】：R714.23
【正文快照】： 随着单绒毛膜双胎发生率的逐年增高,双胎输血综合征(twin-twin transfusion syndrome,TTTS))围生儿死亡率及心血管、神经系统致残率急剧增加,引发各国学者极大关注。中晚孕期超声检查是产前诊断TTTS的首要及主要方法。临床常用Quintero分期标准[1]凭借胎儿已经出现的器官循环

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