目的 探讨双胎输血综合征（TTTS）早产儿合并症发生情况，分析TTTS受血者合并心脏发育异常的临床情况及预后。方法 对2009年6月至2012年12月收治的17对确诊TTTS的早产儿进行回顾性分析。结果 TTTS早产儿供血者体重（1.4±0.6 kg）较受血者体重（1.9±0.6 kg）明显减轻（P<0.05）。经过孕期干预治疗，17对TTTS早产儿中，发生心脏合并症（14例）和脑损伤（12例）患儿较多，其中受血者合并心脏发育异常比例（60%）较供血者高（24%）。10例发生了心脏合并症的受血者中，心脏发育异常主要类型为瓣膜增厚、狭窄或闭锁（50%）。结论 TTTS受血者心脏瓣膜病变和心肌病变合并症发生率高，受血者应该尽早完善胎儿超声心动图，评估心功能，早期治疗以改善预后。
Abstract
Objective To investigate the complications of twin-twin transfusion syndrome (TTTS) in preterm infants and to analyze the clinical conditions and prognosis of cardiac abnormalities in TTTS recipients. Methods A retrospective analysis was performed on the clinical data of 17 pairs of preterm infants with TTTS born between June 2009 and December 2012. Results Compared with the recipients, the donors had significantly lower body weights (1.4±0.6 kg vs 1.9±0.6 kg; P<0.05). With treatment during pregnancy, cardiac complications were found in 14 cases, and brain injuries in 12 cases. The proportion of recipients with cardiac abnormalities (60%) was higher than that of donors (24%). Among 10 recipients who had cardiac complications, cardiac abnormalities mainly included valve thickening, stenosis, or atresia (50%). Conclusions Among preterm infants with TTTS, the recipients are more susceptible to complications of valvular heart disease and cardiomyopathy. Fetal echocardiography, evaluation of cardiac function, and treatment should be performed for recipients as early as possible to improve the prognosis.
关键词
双胎输血综合征 /
先天性心脏病 /
早产儿
Key words
Twin-twin transfusion syndrome /
Congenital heart disease /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Acosta-Rojas R, Becker J, Munoz-Abellana B, et al. Twin chorionicity and the risk of adverse perinatal outcome[J]. Int J Gynaecol Obstet, 2007, 96(2): 98-102.
[2] Lewi L, Jani J, Blickstein I, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study[J]. Am J Obstet Gynecol, 2008, 199(5): 514.e1-514.e8.
[3] Moon-Grady AJ, Rand L, Lemley B, et al. Effect of selective fetoscopic laser photocoagulation therapy for twin-twin transfusion syndrome on pulmonary valve pathology in recipient twins[J]. Ultrasound Obstet Gynecol, 2011, 37(1): 27-33.
[4] Lopriore E, Oepkes D, Walther FJ. Neonatal morbidity in twin-twin transfusion syndrome[J]. Early Hum Dev, 2011, 87(9): 595-599.
[5] de Haseth SB, Haak MC, Roest AA, et al. Right ventricular outflow tract obstruction in monochorionic twins with selective intrauterine growth restriction[J]. Case Rep Pediatr, 2012, 2012: 426825.
[6] Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome[J]. J Am Coll Cardiol, 2001, 38(5): 1533-1538.
[7] Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome[J]. J Perinatol, 1999, 19(8): 550-555.
[8] Habli M, Michelfelder E, Cnota J, et al. Prevalence and progression of recipient-twin cardiomyopathy in early-stage twin-twin transfusion syndrome[J]. Ultrasound Obstet Gynecol, 2012, 39(1): 63-68.
[9] Society for Maternal-Fetal Medicine, Simpson LL. Twin-twin transfusion syndrome[J]. Am J Obstet Gynecol, 2013, 208(1): 3-18.
[10] Van Mieghem T, Done E, Gucciardo L, et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome[J]. Am J Obstet Gynecol, 2010, 202(1): 48.e1-48.e7.
[11] Van Mieghem T, Lewi L, Gucciardo L, et al. The fetal heart in twin-to-twin transfusion syndrome[J]. Int J Pediatr, 2010, 2010: 379792.
[12] Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease[J]. Am J Obstet Gynecol, 2007, 197(4): 392.e1-392.e8.
[13] Crombleholme TM, Shera D, Lee H, et al. A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome[J]. Am J Obstet Gynecol, 2007, 197(4): 396.e1-396.e9.
[14] Karatza AA, Wolfenden JL, Taylor MJ, et al. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies[J]. Heart, 2002, 88(3): 271-277.
[15] 杨森, 朱琦, 陈娇, 等. 胎儿心脏结构异常的超声诊断研究[J]. 中国当代儿科杂志, 2010, 12(2): 99-102.
[16] Van Mieghem T, Martin AM, Weber R, et al. Fetal cardiac function in recipient twins undergoing fetoscopic laser ablation of placental anastomoses for Stage IV twin-twin transfusion syndrome[J]. Ultrasound Obstet Gynecol, 2013, 42(1): 64-69.
[17] Barrea C, Debauche C, Williams O, et al. Twin-to-twin transfusion syndrome: perinatal outcome and recipient heart disease according to treatment strategy[J]. J Paediatr Child Health, 2013, 49(1): E28-E34.
[18] Stirnemann JJ, Nasr B, Proulx F, et al. Evaluation of the CHOP cardiovascular score as a prognostic predictor of outcome in twin-twin transfusion syndrome after laser coagulation of placental vessels in a prospective cohort[J]. Ultrasound Obstet Gynecol, 2010, 36(1): 52-57.
PDF(1174 KB)
