脑-胎盘率在预测双胎输血综合征Ⅱ期中的价值

The predictive value of cerebroplacental ratio in stageⅡof twin-twin transfusion syndrome

目的分析单绒毛膜双羊膜囊(MCDA)双胎合并双胎输血综合征(TTTS)Ⅰ~Ⅱ期时胎儿脑-胎盘血流分布特征,探讨脑-胎盘率(CPR)在预测双胎输血综合征Ⅱ期中的价值。方法回顾性分析2017年6月至2019年6月重庆医科大学附属第一医院诊断的68例TTTS(包括Ⅰ期、Ⅱ期各34例)胎儿脑-胎盘血流参数及其差异,包括脐动脉搏动指数(UA-PI)、大脑中动脉收缩期峰值流速(MCA-PSV)、大脑中动脉搏动指数(MCA-PI)、CPR、UA-PI差异(UA-PIdisc)、MCA-PSV差异(MCA-PSVdisc)、MCA-PI差异(MCA-PIdisc)与CPR差异(CPRdisc)。结果TTTSⅡ期中供血儿与受血儿UA-PI、MCA-PI及CPR差异有统计学意义(均P<0.05);Ⅰ期与Ⅱ期的UA-PIdisc、MCA-PIdisc和CPRdisc差异有统计学意义(均P<0.05)。多因素回归分析显示,只有CPRdisc是TTTSⅡ期的独立预测因素(P<0.05)。ROC曲线显示,CPRdisc诊断TTTSⅡ期的曲线下面积为0.766,敏感性为64.71%,特异性为82.35%(P<0.001)。结论MCDA双胎妊娠合并TTTSⅡ期时,双胎间脑-胎盘血流灌注出现明显差异,其中CPRdisc与Ⅱ期密切相关。

Objective To analyze the cerebroplacental blood flow distribution characteristics in monochorionic-diamniotic(MCDA)twin pregnancies with stageⅠ-Ⅱof twin-twin transfusion syndrome(TTTS),and investigate the predictive value of cerebroplacental ratio(CPR)in the stageⅡof TTTS.Methods The cerebroplacental blood flow distribution were analyzed retrospectively in 68 cases from June 2017 to June 2019 in the First Affiliated Hospital of Chongqing Medical University(34 cases for each stage)with TTTS,including the umbilical artery pulsatility index(UA-PI),middle cerebral artery peak systolic velocity(MCA-PSV),middle cerebral artery pulsatility index(MCA-PI),CPR,and their discordances(UA-PIdisc,MCA-PSVdisc,MCA-PIdisc and CPRdisc).Results The differences of UA-PI,MCA-PI,and CPR between donors and recipients in TTTSⅡwere statistically significant(all P<0.05),the differences of UA-PIdisc,MCA-PIdisc and CPRdisc between TTTSⅠand TTTSⅡwere statistically significant(all P<0.05).Multivariate Logistic regression analyses showed that only CPRdisc was independently associated with the stageⅡof TTTS(P<0.05),and it had moderate predictive accuracy for the stageⅡof TTTS with an area under the curve of 0.766,a sensitivity of 64.71%and a specificity of 82.35%(P<0.001).Conclusions More cerebroplacental blood flow discordances are observed and CPRdisc is closely related to stageⅡof TTTS.