基于信息量模型的单绒毛膜双羊膜囊双胎心脏功能异常围产结局预测

Prediction of Perinatal Outcomes for Cardiac Dysfunction in Monochorionic Diamniotic Twin Pregnancies Based on Information Model

目的:分析单绒毛膜双羊膜囊(MCDA)双胎心脏功能异常的特点,并基于信息量法选择以超声指标为主的相关评价指标以建立预测MCDA胎儿围产结局的模型。方法:筛选出双胎妊娠孕妇中超声检查提示胎儿心脏异常者104例,根据其绒毛膜性和胎儿心脏异常情况分为:MCDA功能异常组(61例)、MCDA结构异常组(23例)及双绒毛膜双羊膜囊(DCDA)结构异常组(20例),分析比较3组临床特征的差异并随访临床结局至产后3年。引入信息量法,选择MCDA功能异常组的全部超声异常指标(7类),再加入3项常见临床指标,纳入信息量模型计算,建立胎儿心脏功能异常的围产结局预测模型,同时采用受试者工作特征(ROC)曲线和预留病例(5例)检验两种方法评估模型预测的有效性。结果:①与MCDA结构异常组比较,MCDA功能异常组双胎特有并发症的比例更高、分期更重;3组围产结局中活产与未活产所占比率、不同的活产结局间和不同的未活产结局间的差异均无统计学意义(P>0.05),但随访发现MCDA功能异常组活产儿大部分(22/24)心脏功能自行恢复正常。②信息量模型预测结果示,胎儿心脏功能异常的不良围产结局或风险(I)划分标准:当I>1.0时,胎儿死亡风险高;当-1.0<I≤1.0时,胎儿死亡风险中等;当I≤-1.0时,胎儿死亡风险低。③ROC曲线验证结果示,AUC为0.864(95%CI 0.767~0.961);预留病例检验验证结果示,与实际临床结局吻合程度较高。结论:基于信息量法的结局预测模型与胎儿心脏功能异常的血流动力学机制有一定关联性,对预测MCDA心脏功能异常胎儿死亡风险有较高价值。

Objective:To investigate the characteristics of fetal cardiac dysfunction in monochorionic diamniotic(MCDA)twin pregnancies,and establish a prediction model for their perinatal outcomes mainly based on ultrasound indicators using information method.Methods:A total of 104 twin cases with ultrasound indicating fetal heart abnormalities were selected.Based on their chorionic and fetal heart abnormalities,they were divided into three groups:MCDA dysfunction group(61 cases),MCDA structural abnormalities group(23 cases),and dichorionic diamniotic(DCDA)structural abnormalities group(20 cases).The clinical features of the three groups were analyzed and compared,and clinical outcomes were followed up until 3 years postpartum.A perinatal outcome prediction model for fetal cardiac dysfunction was established using the information method.All ultrasound abnormal indicators(7 categories)from the MCDA functional abnormality group,as well as 3 common clinical indicators,were included in the information model calculation.At the same time,the effectiveness of the model prediction was evaluated using receiver operating characteristic(ROC)curves and reserved cases(5 cases).Results:①Compared with the group with MCDA structural abnormalities,the group with MCDA functional abnormalities had a higher proportion of twin specific complications and a more severe staging.There was no statistically significant difference(P>0.05)in the proportion of live and non-live birth among the three groups,as well as the differences between different live birth outcomes and non-live birth outcomes.However,follow-up found that the majority(22/24)of live births in the MCDA dysfunction group had their heart function returning to normal on their own.②The prediction results of the information model showed that the classification criteria for adverse perinatal outcome or risks(I)of fetal cardiac dysfunction were:when I>1.0,the risk of fetal death was high;when-1.0<I≤1.0,the risk of fetal death was moderate;when I≤-1.0,the risk of fetal death was low.③The ROC curve validation results show that the AUC was 0.864(95%CI 0.767-0.961).The validation results of the reserved case test showed a high degree of agreement with the actual clinical outcomes.Conclusions:The outcome prediction model based on the information method has a certain correlation with the hemodynamic mechanism of fetal cardiac dysfunction,which has high value in predicting the risk of fetal death due to MCDA cardiac dysfunction.