妊娠早期超声指标对复杂单绒毛膜双羊膜双胞胎的预测价值

Q4 Medicine

中华围产医学杂志 Pub Date : 2019-10-16 DOI:10.3760/CMA.J.ISSN.1007-9408.2019.10.011

Qi Xu, Yi Zhou, D. Huang, Yanjun Chen, Lin-fen Huang

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引用次数: 0

摘要

目的探讨妊娠早期超声参数对复杂单绒毛膜双羊膜儿(MCDA)的预测价值。方法回顾性研究选取2013年1月至2018年1月中山大学第一附属医院超声诊断为MCDA双胞胎的孕妇，分为4组:无并发症MCDA双胞胎组、双胎输血综合征(TTTS)组、选择性宫内生长受限(sIUGR)组和双胎贫血-红细胞增多症序列(TAPS)组。记录妊娠11-14周时颈透明厚度(NT)、冠臀长度(CRL)、脐带插入(UCI)和静脉导管(DV)流量。采用t检验、卡方(或Fisher’s exact)检验、多元logistic回归分析和受试者工作特征(ROC)曲线对复杂MCDA双胞胎的预测值进行分析。结果(1)本研究共纳入430例MCDA双胎妊娠，其中TTTS组152例，sIUGR组142例，TAPS组7例，正常MCDA组129例。由于样本量小，未对TAPS组进行进一步分析。(2) TTTS组双胞胎NT不一致性显著高于正常MCDA组[(21.5±16.0)% vs(14.6±13.5)%，t=-3.533, P<0.001]。NT不一致性预测TTTS的ROC曲线下面积(AUC)为0.649。分层分析显示，当NT不一致性为20%时，TTTS的预测效果最佳，敏感性为57.9%，特异性为70.6%。(3)与正常MCDA双胞胎组相比，sIUGR组的CRL和NT差异更大，UCI差异更高[NT:(27.8±21.3)% vs(14.6±13.5)%，t=-5.556, P<0.001;CRL:(8.6±6.9)% vs(5.4±4.4)%,t = -3.144, P = 0.002;UCI: 47.9%(68/142)和13.9%(18/129),χ2 = 35.929,P < 0.001)。NT不一致预测的sIUGR AUC为0.675,CRL不一致预测的AUC为0.649。分层分析显示，NT不一致性为20%，CRL不一致性为10%是sIUGR的最佳预测指标，敏感性分别为53.1%和34.7%，特异性分别为72.1%和83.8%。多因素logistic回归分析显示，UCI不一致是sIUGR的危险因素(OR=7.165, 95%CI: 2.637 ~ 19.472)。结论妊娠早期NT不一致性大于20%的MCDA双胞胎TTTS风险增加。CRL不一致大于10%、NT不一致大于20%及UCI异常是sIUGR的危险因素。关键词:双胞胎;同卵;妊娠三个月，第一;产前超声;颈部半透明测量;Fetofetal输血;胎儿生长迟缓;预测

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Predictive value of first-trimester ultrasound markers for complicated monochorionic diamniotic twins

Objective To investigate the value of first-trimester ultrasound parameters in predicting complicated monochorionic diamniotic (MCDA) twins. Methods In this retrospective study, pregnant women diagnosed as MCDA twins by ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to January 2018 were recruited and divided into the following four groups: non-complicated MCDA twins group, twin-twin transfusion syndrome (TTTS) group, selective intrauterine growth restriction (sIUGR) group and twin anemia-polycythemia sequence (TAPS) group. Thickness of nuchal translucency (NT), crown-rump length (CRL), umbilical cord insertion (UCI) and ductus venosus (DV) flow at 11-14 weeks of gestation were recorded. The predictive value for complicated MCDA twins was analyzed using t-test, Chi-square (or Fisher's exact) test, multivariate logistic regression analysis and receiver operating characteristic (ROC) curve. Results (1) A total of 430 MCDA twin pregnancies were included in this study with 152 in the TTTS group, 142 in the sIUGR group, seven in the TAPS group and 129 in the normal MCDA twins group. No further analysis was performed on the TAPS group due to the small sample size. (2) NT discordance in twins of the TTTS group was significantly greater than that in the normal MCDA twins group[(21.5±16.0)% vs (14.6±13.5)%, t=-3.533, P<0.001]. The area under ROC curve (AUC) of TTTS predicted by NT discordance was 0.649. Stratified analysis showed that TTTS was best predicted when NT discordance was 20% with the sensitivity of 57.9% and specificity of 70.6%. (3) The sIUGR group had greater discordance in CRL and NT and higher UCI discordance than the normal MCDA twins group [NT: (27.8±21.3)% vs (14.6±13.5)%, t=-5.556, P<0.001; CRL: (8.6±6.9)% vs (5.4±4.4)%, t=-3.144, P=0.002; UCI: 47.9% (68/142) vs 13.9% (18/129), χ2=35.929, P<0.001]. The AUC of sIUGR was 0.675 predicted by NT discordance and 0.649 by CRL discordance. Stratified analysis showed that NT discordance of 20% and CRL discordance of 10% were the best prediction for sIUGR with the sensitivity of 53.1% and 34.7% and specificity of 72.1% and 83.8%, respectively. Multivariate logistic regression analysis suggested that UCI discordance was the risk factor for sIUGR (OR=7.165, 95%CI: 2.637-19.472). Conclusions MCDA twins with NT discordance greater than 20% during early pregnancy are at increased risk for TTTS. CRL discordance greater than 10%, NT discordance greater than 20% and abnormal UCI are risk factors for sIUGR. Key words: Twins, monozygotic; Pregnancy trimester, first; Ultrasonography, prenatal; Nuchal translucency measurement; Fetofetal transfusion; Fetal growth retardation; Forecasting

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来源期刊

中华围产医学杂志 Medicine-Obstetrics and Gynecology

CiteScore

0.70

自引率

0.00%

发文量

4446

期刊介绍： Chinese Journal of Perinatal Medicine was founded in May 1998. It is one of the journals of the Chinese Medical Association, which is supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by Peking University First Hospital. Perinatal medicine is a new discipline jointly studied by obstetrics and neonatology. The purpose of this journal is to "prenatal and postnatal care, improve the quality of the newborn population, and ensure the safety and health of mothers and infants". It reflects the new theories, new technologies, and new progress in perinatal medicine in related disciplines such as basic, clinical and preventive medicine, genetics, and sociology. It aims to provide a window and platform for academic exchanges, information transmission, and understanding of the development trends of domestic and foreign perinatal medicine for the majority of perinatal medicine workers in my country.