胎儿颈部透明层厚度预测早期双胎输血综合征的效果分析

Clinical study of early predictive value of fetal nuchal translucency for twin to twin transfusion syndrome

目的：探讨双胎颈部皮肤透明层厚度（NT）差值预测双胎输血综合征（TTTS）的临床价值。方法：对接受产前超声检查且被追踪到妊娠结局的单绒毛膜双羊膜囊（MCDA）双胎孕妇136例的临床资料进行回顾性分析,其中TTTS 20例为TTTS组,非TTTS 116例为非TTTS组。比较两组双胎NT差值≥0.6mm（或≥20%）者的比率,并计算以双胎NT差值≥0.6mm（或≥20%）预测TTTS的敏感度、特异度、阳性预测值、阴性预测值。结果：TTTS组和非TTTS组双胎NT差值≥0.6mm（或≥20%）的发生率分别为35.0%（7/20）及12.9%（15/116）,差异有统计学意义（P〈0.05）;双胎NT差值≥0.6mm（或≥20%）发生TTTS的相对危险度（OR）为3.626（95%CI：1.247~10.538）;预测TTTS的敏感度、特异度、阳性预测值及阴性预测值分别为35.0%、87.1%、31.8%及88.6%。结论：在MCDA双胎中,双胎NT差值≥0.6mm（或≥20%）是TTTS发生的危险因素,对早期预测TTTS有一定的临床参考价值。

Objective：To explore the predictive value of fetal nuchal translucency（NT）on twin to twin transfusion syndrome（TTTS）.Methods：A retrospective study was conducted,which included 136 pregnant women with monochorionic diamniotic（MCDA）from department of obstetrics,the first affiliated hospital of Kunming Medical University from January 2011 to January 2015.20 pregnant women with TTTS were in the TTTS group,and 120 pregnant women with non TTTS were in the non TTTS group.The rate of fetal NT difference value（D-value）≥0.6mm（≥20%）was compared between the two groups.And sensitivity,specificity,positive predictive value（PPV）,negative predictive value（NPV）of NT D-value≥ 0.6mm（≥20%）for predictive TTTS were analyzed.Results：The rate of fetal NT difference value（D-value）≥0.6mm（≥20%）was 35.0%（7/20）in the TTTS group and 12.9%（15/116）in the non TTTS group,respectively,which had significant different（P0.05）.The pregnant women with NT D value≥ 0.6mm（≥20%）had higher risk of TTTS compared with those with NT D value0.6mm（OR 3.626,95%CI 1.247-10.538）.The sensitivity,specificity,PPV and NPV of NT D value≥ 0.6mm（≥20%）for predicting TTTS was 35.0%,87.1%,31.8%and 88.6%,respectively.Conclusion：NT D value≥0.6mm（≥20%）may be a risk factor for TTTS,and it has some value in early predicting TTTS.