镜像综合征21例临床分析

Clinical study on 21 cases with mirror syndrome

目的探讨镜像综合征的临床特点、治疗和预后。方法回顾性分析2008年1月至2012年3月深圳市妇幼保健院收治的21例镜像综合征患者的临床资料,包括临床特点、治疗措施和母婴结局。结果 (1)发病原因:21例镜像综合征患者(其中1例为双胎)均存在胎儿-胎盘-母体三联水肿,胎儿水肿原因分别为巴氏水肿胎(15例)、胎儿复杂心脏畸形(2例)、双胎输血综合征(1例)、胎儿微小病毒B19感染(1例),不明原因(2例);(2)临床表现:21例患者均出现不同程度水肿,18例有蛋白尿,10例出现血压升高,1例头痛;(3)实验室检查:20例出现血液稀释,19例发生低蛋白血症,19例血尿酸升高;(4)并发症及治疗:12例产后出血中9例进行输血治疗,8例胎盘粘连均行人工剥离胎盘;(5)预后:21例患者痊愈出院,22例新生儿仅存活2例。结论胎儿、胎盘和母体三者均出现水肿时可确诊镜像综合征,一旦确诊针对胎儿水肿原因进行治疗,如果病情不可控制,应果断终止妊娠。

Objective To explore the clinical features, treatment and prognosis of mirror syndrome.Methods Between January 2008 and March 2012, 21 cases with mirror syndrome who admitted to the Shenzhen Maternity and Child Healthcare Hospital of South Medical University were retrospectively studied.The clinical data included clinical feature, managment and outcomes of mothers and fetuses.Results （1） Etiology：21 cases with mirror syndrome were presented the triad of maternal edema, hydrops fetalis and hydropic placenta, including 15 cases of Bart′s hydrops fetalis, 2 cases of fetal complex heart malformation, 1 case of twin-to-twin transfusion syndrome, 1 case of parvovirus B19 infection, and 2 case of unknown etiology.（2）Clinical manifestation：21 cases with mirror syndrome were all presented varying degrees of maternal edema, 18 cases presented proteinuria, 10 cases presented elevated blood pressure and 1 case presented headache.（ 3 ） Laboratory findings： 20 patients presented hemodilution, 19 patients presented hypoproteinemia, 19 patients and elevated uric acid.（4） Complication and therapy： Postpartum hemorrhage could be found in12 cases, and 9 cases need transfuse blood. Placenta accreta could be found in eight cases, and they were all received manual removal of placenta. （5） Prognosis： 21 cases with mirror syndrome were recovered and discharged; however, of all the 22 newborns only 2 babies survived.Conclusions Mirror syndyrome can be diagnosed as the maternal edema with hydrops fetalis and hydropic placenta.When the patient was diagnosed as mirror syndrome, treatment for the hydrops fetalis etiology should be given.If the condition cannot be controlled, termination of pregnancy should be made as soon as possible.