镜像综合征15例临床诊治分析

Diagnosis and treatment of 15 cases with mirror syndrome

目的探讨镜像综合征的临床特点、诊断及治疗方法。方法回顾性分析2008年1月至2015年3月广州医科大学附属第六医院收治的15例镜像综合征患者的临床资料。结果(1)发病原因:15例镜像综合征患者中14例为Bart's水肿胎,另一例原因不明;(2)临床表现:15例病例中,5例出现少尿或无尿,3例血压升高、2例上腹痛、1例出现头痛;(3)实验室检查:15例母体均出现不同程度贫血、血液稀释、低蛋白血症及D-二聚体升高,5例肌酐升高、13例尿酸升高、13例酸中毒;(4)超声及病理检查:15例超声检查均提示胎儿水肿,胎盘厚度平均值为(70.87±14.12)mm,胎盘病理检查均提示胎盘绒毛水肿;(5)母体并发症:12例产后出血、6例胎盘粘连、5例急性肾功能衰竭、3例急性心功能衰竭、2例急性肺水肿、1例胎盘早剥、1例羊水栓塞、1例弥散性血管内凝血、1例代谢性脑病。结论母体水肿伴随胎儿水肿和(或)胎盘水肿即可确诊镜像综合征,除了出现类似子痫前期的临床表现外,还表现血液稀释的显著特点。镜像综合征一经确诊,如病情不可逆,应果断终止妊娠。

Objective To discuss the clinical features, diagnosis and therapy of mirror syndrome. Methods Clinical data of 15 cases with mirror syndrome admitted to the Six Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2015 were retrospectively analyzed. Results （1） Etiology： In fifteen cases of mirror syndrome, 14 cases were Bart＇s hydrops fetalis, and 1 case was unknown etiology. （2） Clinical manifestation： In the 15cases, $ cases presented oliguria, 3 cases presented elevated blood pressure, 2 cases presented stomach pain, 1 cases presented headache. （3） Laboratory findings： All the patients presented anemia, hemodilution, hypoproteinemia, and elevated D- Dimer. Five cases presented elevated creatinine, 13 cases presented elevated uric acid and 13 cases presented acidosis. （4） Ultrasonography and pathological examinations：Fetal ultrasound of the 15 fetuses revealed hydrops fetalis, and the placenta thickness was [ mean （70. 87±14. 12） ] mm. The pathological examination of placenta indicated edematous in 15 cases. （5）Maternal complications： 12 cases had postpartum hemorrhage, 6 cases had placenta adhesion, 5 cases had acute kidney failure, 3 cases had acute heart failure, 2 cases had acute pulmonary edema, 1 case had placental abruption, 1 case had amnionic fluid embolism, 1 case had disseminated intravascular coagulation, 1 case had metabolic encephalopathy. Conclusions Maternal edema with hydrops fetalis and/or hydropic placenta could be diagnosed as mirror syndrome. Except for preeclampsia-like manifestation, it had the feature of maternal hemodilution. When the patient was diagnosed as mirror syndrome and the condition out of control, pregnancy should be terminated as soon as possible.