妊娠11~13^(+6)周预测单绒毛膜性双胎选择性胎儿生长受限的超声指标筛选研究

Screening of ultrasound markers for predicting selective fetal growth restriction in monochorionic twins at 11-13^(+6)weeks

目的筛选妊娠11~13^(+6)周预测单绒毛膜性(MC)双胎选择性胎儿生长受限(sFGR)的超声指标。方法回顾性分析2020年6月至2021年12月在首都医科大学附属北京妇产医院前瞻性收集的MC双胎孕妇,妊娠11~13^(+6)周行规范化超声检查,根据专家共识中的sFGR诊断标准,将孕妇分为sFGR组和对照组(正常MC双胎组),比较两组孕妇年龄、孕产史、受孕方式以及两胎儿颈项透明层(NT)厚度、NT差异、头臀长(CRL)差异、静脉导管频谱异常及脐带插入位置异常发生率,组间差异有统计学意义的指标进一步分析,筛选可用于预测sFGR的早期超声指标。结果共106例纳入分析,sFGR组30例,对照组76例。①与对照组相比,sFGR组两胎儿均存活病例胎儿低出生体重(低于第10、第3百分位)发生率高,双胎出生体重差异大,双胎出生体重不一致(差值大于25%)发生率高(均P<0.001);②与对照组相比,sFGR组两胎儿CRL差异大[7.8%(3.8%,9.2%)比3.8%(1.5%,7.2%)],脐带插入位置异常发生率高(33.3%比6.6%),差异有统计学意义(P=0.004,<0.001),而双胎NT差异、双胎NT增厚及静脉导管频谱异常差异无统计学意义(均P>0.05);③双胎CRL差异是sFGR的危险因素(OR=1.136,95%CI=1.021~1.264),预测sFGR的ROC曲线下面积为0.682(95%CI=0.576~0.787),截断值为6.5%时敏感性为0.567,特异性为0.737;脐带插入位置异常是sFGR的危险因素(OR=7.100,95%CI=2.176~23.167),预测sFGR的敏感性为0.333,特异性为0.934。结论双胎CRL差异、脐带插入位置异常是发生sFGR的危险因素,对预测MC双胎发生sFGR具有一定价值。

Objective To screen the ultrasound markers of predictive value at 11-13^(+6) weeks for selective fetal growth restriction(sFGR)in monochorionic(MC)twins.Methods A retrospective analysis of MC twin pregnancies collected prospectively from June 2020 to December 2021 at Beijing Obstetrics and Gynecology Hospital,Capital Medical University,with standardized ultrasound examinations performed at 11-13^(+6) weeks.According to the expert consensus on the diagnostic criteria for sFGR,collected MC twin pregnancies were divided into sFGR group and control group(normal MC twin group).Maternal age,maternal history,mode of conception,the incidence of increased nuchal translucency(NT)thickness,NT discordance,crown-rump length(CRL)discordance,abnormal ductus venous Doppler waveform and abnormal umbilical cord insertion position were compared between the two groups,and those markers that differed between groups were further analyzed for screening early ultrasound markers that could be used to predict sFGR.Results A total of 106 cases were included in the analysis,30 cases in sFGR group and 76 cases in control group.①Compared with control group,sFGR group had a higher incidence of low fetal birth weight(below the 10th and 3rd percentile)in both surviving cases,large birth weight discordance and a higher incidence of birth weight inconsistency(difference>25%)(P<0.001).②Compared with control group,the CRL discordance was larger in sFGR group[7.8%(3.8%,9.2%)versus 3.8%(1.5%,7.2%)]and the incidence of abnormal cord insertion position(33.3%versus 6.6%)was higher,the differences were statistically significant(P=0.004 and<0.001,respectively),whereas the differences of NT discordance,incidence of increased NT and abnormal ductus venous Doppler waveform were not statistically significant(all P values>0.05).③CRL discordance was a risk factor for sFGR(OR=1.136,95%CI=1.021-1.264),with an area under the ROC curve of 0.682(95%CI=0.576-0.787)for predicting sFGR,the sensitivity and specificity were 0.567 and 0.737 at a cut-off value of 6.5%.Abnormal umbilical cord insertion position was a risk factor for sFGR(OR=7.100,95%CI=2.176-23.167)with a sensitivity of 0.333 and specificity of 0.934 for predicting sFGR.Conclusions CRL discordance and abnormal cord insertion position are risk factors for the development of sFGR and are of value in predicting sFGR in MC twins.