早孕期胎儿颈项透明层厚度和静脉导管频谱检查对双胎输血综合征的预测价值
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摘要
目的探讨早孕期胎儿颈项透明层(NT)厚度和静脉导管(DV)频谱异常在预测双胎输血综合征(TTTS)的意义。资料与方法回顾性分析2015年10月—2017年9月珠海市妇幼保健院产科单绒双羊双胎347例,NT、DV频谱超声检查时间为孕11～14周。其中正常单绒毛膜性双胎334例,TTTS双胎13例。比较正常组与TTTS组11～14周2个胎儿NT值、NT差值及DV频谱。结果 TTTS组双胎NT差值为(0.71±0.09)mm,正常双胎NT差值为(0.28±0.01)mm,两组比较,差异有统计学意义(P<0.05)。TTTS组DV频谱异常8例,正常组4例,两组比较,差异有统计学意义(P<0.05)。结论早孕期2个胎儿NT差值和DV频谱异常均对预测TTTS有一定意义,两者联合对预测TTTS风险更有意义。
Purpose To investigate the significance of fetal nuchal translucency(NT) thickness and ductus venosus(DV) spectrum abnormality in predicting twin-twin transfusion syndrome(TTTS) during early pregnancy. Materials and Methods A retrospective analysis of 347 cases of monochorionic and double amniotic sac twin pregnancies in Zhuhai Maternal and Child Health Hospital from October 2015 to September 2017. The time of ultrasound examination of NT and DV was taken between 11-14 weeks of gestation. According to their results, 334 cases were normal monochorionic twins and 13 cases were TTTS twins. Compared the fetal NT value, NT difference and DV spectrum between the normal group and the TTTS group for 11-14 weeks of gestation. Results The difference of twin NT in the TTTS group was(0.71±0.09) mm, which was(0.28±0.01) mm in the normal group. The difference between the two groups was statistically significant(P<0.05). There were 8 cases with abnormal DV spectrum in the TTTS group which compared to 4 cases with abnormal DV spectrum in the normal group. The difference between the two groups was statistically significant(P<0.05). Conclusion Both the two NT differences and DV spectrum abnormalities in early pregnancy have certain significance for predicting TTTS. The joint of the two could be more meaningful for predicting TTTS risk.
Purpose To investigate the significance of fetal nuchal translucency(NT) thickness and ductus venosus(DV) spectrum abnormality in predicting twin-twin transfusion syndrome(TTTS) during early pregnancy. Materials and Methods A retrospective analysis of 347 cases of monochorionic and double amniotic sac twin pregnancies in Zhuhai Maternal and Child Health Hospital from October 2015 to September 2017. The time of ultrasound examination of NT and DV was taken between 11-14 weeks of gestation. According to their results, 334 cases were normal monochorionic twins and 13 cases were TTTS twins. Compared the fetal NT value, NT difference and DV spectrum between the normal group and the TTTS group for 11-14 weeks of gestation. Results The difference of twin NT in the TTTS group was(0.71±0.09) mm, which was(0.28±0.01) mm in the normal group. The difference between the two groups was statistically significant(P<0.05). There were 8 cases with abnormal DV spectrum in the TTTS group which compared to 4 cases with abnormal DV spectrum in the normal group. The difference between the two groups was statistically significant(P<0.05). Conclusion Both the two NT differences and DV spectrum abnormalities in early pregnancy have certain significance for predicting TTTS. The joint of the two could be more meaningful for predicting TTTS risk.
引文
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[7]吴斯瑶,陈秋妍,谢润桂,等.21-三体综合征胎儿产前超声诊断价值(附152例分析).医学影像学杂志,2018,28(3):459-463.
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[11]廖森成,杨春波,何敏仪,等.超声联合检查胎儿颈项透明层、静脉导管及脐带附着方式预测双胎输血综合征的价值.实用医学杂志,2016,32(6):973-975.
[12]Espinoza J,Shamshirsaz A,Ruano R,et al.Transient twin reversed arterial perfusion:a protective effect in twin-to-twin transfusion syndrome?Ultrasound in Obstetrics&Gynecology,2016,47(3):380-381.
[2]Quintero RA,Morales WJ,Allen MH,et al.Staging of twintwin transfusion syndrome.J Perinatol,1999,19(8 Pt 1):550-555.
[3]Paek B,Dorn M,Walker M.Atypical twin-to-twin transfusion syndrome:prevalence in a population undergoing fetoscopic laser ablation of communicating placental vessels.Am J Obstet Gynecol,2016,215(1):115.
[4]李晓菲,姚苓,韩吉晶,等.双胎妊娠并发症孕妇血管阻力及子宫动脉血流参数纵向研究.中国医学影像学杂志,2018,26(6):442-445.
[5]Zhao DP,Cambiaso O,Otańa L,et al.Veno-venous anastomoses in twin-to-twin transfusion syndrome:a multicenters study.Placenta,2015,36(8):911-914.
[6]孙丽娟,王欣,吴青青,等.超声检查胎儿颈项透明层厚度在筛查胎儿染色体异常中的价值.中华妇产科杂志,2013,48(11):819-823.
[7]吴斯瑶,陈秋妍,谢润桂,等.21-三体综合征胎儿产前超声诊断价值(附152例分析).医学影像学杂志,2018,28(3):459-463.
[8]Zipori Y,Reidy K,Gilchrist T,et al.The outcome of monochorionic diamniotic twins discordant at 11 to 13(+6)weeks'gestation.Twin Research and Human Genetics,2016,19(6):692-696.
[9]Haugen G,Kiserud T,Godfrey K,et al.Portal and umbilical venous blood supply to the liver in the human fetus near term.Ultrasound in Obstetrics&Gynecology,2004,24(6):599-605.
[10]姜纬,邓学东,章茜,等.中孕期静脉导管多普勒血流参数在预测胎儿生长受限中的应用研究.医学影像学杂志,2015,25(2):308-312.
[11]廖森成,杨春波,何敏仪,等.超声联合检查胎儿颈项透明层、静脉导管及脐带附着方式预测双胎输血综合征的价值.实用医学杂志,2016,32(6):973-975.
[12]Espinoza J,Shamshirsaz A,Ruano R,et al.Transient twin reversed arterial perfusion:a protective effect in twin-to-twin transfusion syndrome?Ultrasound in Obstetrics&Gynecology,2016,47(3):380-381.