双胎输血综合征预后不良的影响因素分析

Influencing factors of poor prognosis of twin-to-twin transfusion syndrome

目的探讨分析双胎输血综合征(TTTS)所致预后不良的影响因素。方法收集2018年1月至2021年5月在广东省妇幼保健院新生儿科住院的TTTS患儿的临床资料,根据供体和受体分为供血组和受血组,根据预后结局分为预后不良组和预后良好组,并进行回顾性分析。结果共纳入86例有效病例,供血组和受血组在性别、出生胎龄、剖宫产、Apgar评分、肌酐最大值、低血压发生率、血管活性药物评分最大值方面比较差异均无统计学意义(均P>0.05);供血组的出生体质量、生后初始血红蛋白值分别为(1.39±0.45)kg、(159.90±27.95)g/L,均低于受血组的(1.67±0.48)kg、(173.75±29.73)g/L,差异均有统计学意义(均P<0.05),供血组小于胎龄儿的发生率高于受血组[38.1%(16/42)比4.5%(2/44)],差异有统计学意义(P<0.001);两组病例中新生儿呼吸窘迫综合征、支气管肺发育不良、动脉导管未闭、坏死性小肠结肠炎、早产儿视网膜病、败血症、心脏异常表现和脑损伤发生率比较差异均无统计学意义(均P>0.05)。预后不良组与预后良好组中性别、剖宫产率、小于胎龄儿发生率、初始血红蛋白值、血肌酐最大值、Quintero分期和产前是否治疗的比较差异均无统计学意义(均P>0.05);两组中受血者与供血者比例及发生TTTS孕周比较差异均无统计学意义(均P>0.05);预后不良组的出生胎龄[(29.56±2.40)周]、出生体质量[(1.23±0.46)kg]、Apgar评分均低于预后良好组(均P<0.05),血管活性药物评分最大值高于预后良好组[7(29)比0(5)],差异有统计学意义(P<0.001);两组中支气管肺发育不良、早产儿视网膜病、坏死性小肠结肠炎、败血症的发生率比较差异均无统计学意义(均P>0.05),预后不良组中新生儿呼吸窘迫综合征[100.0%(19/19)]、动脉导管未闭[52.6%(10/19)]、急性肾损伤[22.1%(4/19)]、低血压[57.9%(11/19)]及心脏异常表现[63.2%(12/19)]的发生率均高于预后良好组,差异均有统计学意义(均P<0.05),其中心脏异常表现中的肺动脉高压、心功能不全、右向左分流、三尖瓣反流、二尖瓣反流的发生率明显升高。结论TTTS可导致新生儿预后不良,心脏异常表现及血流动力学异常与预后不良相关。

Objective To investigate the influencing factors of the poor prognosis of twin-to-twin transfusion syndrome(TTTS).Methods The clinical data of the children with TTTS who were hospitalized in Department of Neonatology,GuangdongWomen and Children Hospital from January 2018 toMay 2021were collected.The childrenwere divided into a donor group and a recipient group,and into a poor prognosis group and a good prognosis group according to the prognosis outcomes.The data were retrospectively analyzed.Results A total of 86 effective cases were included.There were no statistical differences in gender,gestational age at birth,cesarean section,Apgar score,maximum creatinine,incidence of hypotension,and maximum vasoactive drug score(VISmax)between the donor group and the recipient group(all P>0.05).The birth weight,initial hemoglobin level,and incidence of small-for-gestational age infants(SGA)were(1.39±0.45)kg,(159.90±27.95)g/L,and 38.1%(16/42)in the donor group,and were(1.67±0.48)kg,(173.75±29.73)g/L,and 4.5%(2/44)in the recipient group,with statistical differences(all P<0.05).There were no statistical differences in the incidences of neonatal respiratory distress syndrome(RDS),bronchopulmonary dysplasia(BPD),patent ductus arteriosus(PDA),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP),sepsis,abnormal cardiac manifestations,and brain injury between the two groups(all P>0.05).There were no statistical differences in gender,cesarean section rate,SGA incidence,initial hemoglobin level,maximum serum creatinine value,and Quintero staging of TTTS and treatment or no treatment before delivery between the poor prognosis group and the good prognosis group(all P>0.05).There were no statistical differences in the proportion of recipients and the TTTS pregnancy week between the two groups(both P>0.05).The gestational age at birth,birth weight,and Apgar score were(29.56±2.40)weeks,(1.23±0.46)kg,and(6.36±1.53)in the poor prognosis group,which were lower than those in the good prognosis group,with statistical differences(all P<0.05).The VISmax in the poor prognosis group was higher than that in the good prognosis group[7(29)vs.0(5)],with a statistical difference(P<0.001).There were no statistical differences in the incidences of BPD,ROP,NEC,and sepsis between the two groups(all P>0.05).The incidences of RDS,PDA,acute kidney injury,hypotension,and abnormal cardiac manifestations were 100.0%(19/19),52.6%(10/19),22.1%(4/19),57.9%(11/19),and 63.2%(12/19)in the poor prognosis group,which were higher than those in the good prognosis group,with statistical differences(all P<0.05).Among the abnormal cardiac manifestations,the incidences of pulmonary artery hypertension,cardiac insufficiency,right-to-left shunt,mitral regurgitation,and tricuspid regurgitation were significantly increased.Conclusions TTTS can lead to poor prognosis of newborns.Abnormal cardiac manifestations and hemodynamic abnormalities are related to their poor prognosis.