| 摘要: |
| 目的 探讨双胎儿生长发育不协调对早孕早期妊娠8-11周产前超声诊断双胎反向动脉灌注序列征(twin reversed arterial perfusion sequence, TRAPS)的预测价值。方法 收集2001年5月至2021年8月湖北省妇幼保健院产前超声诊断并经引产后或产后病理证实的诊断的153例TRAPS,回顾性分析37例在妊娠8-11周的产前超声检查,同时收集42例产前超声系统检查及产后随访未见明显结构异常的早孕期单绒毛膜双胎妊娠为对照组,总结其超声特点并分别统计两胎儿在早孕早期超声孕周大小对应的天数差别及胚胎长度差别,使用受试者工作曲线(ROC)评价其在早孕期对TRAPS的预测价值。结果 1、37例TRAPS中36例为双胎妊娠,1例为三胎妊娠,42例正常组均为双胎妊娠； 2、37例TRAPS中较大的胚胎均可见正常心管搏动,较小的胚胎34例未见明显心管搏动,3例可见心管搏动,42例对照组双胎儿均可见正常心管搏动。3、两组孕妇年龄及两组胎儿的临床孕周比较无统计学差异(P>0.05)；研究组及对照组两胚胎超声孕周相差天数分别为9.1±6.9天、1.6±1.5天,两组结果比较具有统计学差异(P<0.05)；研究组和对照组双胎儿胚胎长度差别分别为10.3±7.7mm、1.9±1.9mm,两组结果比较具有统计学差异(P<0.05)； 4、应用受试者工作(ROC)曲线分析得出当以两胎儿相差天数≥5天、两胚胎长度≥4.5mm分别作为预测TRAPS的截断值时,其曲线下面积、敏感度、特异度、阳性预测值、阴性预测值分别为0.65 vs 0.66、67.6% vs 75.7%、97.6% vs 97.5%、92.3% vs 87.8%、77.3% vs 82.2% 。结论 双胎儿生长发育不协调且其中之一胚胎未见明显心管搏动对早孕期妊娠8-11周预测TRAPS的发生具有较高的价值。 |
| 关键词: 产前超声诊断 早孕期 双胎无心动脉反向灌注序列征 |
| DOI： |
| 投稿时间：2022-06-16修订日期：2022-08-23 |
| 基金项目:湖北省卫健委面上项目(WJ2021M188) |
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| The value of twins’ growth and development discrepancy in early pregnancy predicting twin reversed arterial perfusion sequenceJi xiuqin, Yang xiaohong, Zhao sheng, Liu liping, Qin meilan, Wang weiyun, Gaoyanduo, Zhang xiaoyan |
| 戢 |
| () |
| Abstract: |
| Objective To investigate the predictive value of twins’growth and development discrepancy in prenatal ultrasound diagnosis of twin reversed arterial perfusion sequence (TRAPS) in the first trimester of pregnancy at 8-11 weeks of pregnancy. Methods From May 2001 to August 2021, the prenatal ultrasound diagnosis of Hubei Province Maternal and Child Health Hospital and the diagnosis confirmed by post-induction or post-natal pathology were collected 153 Cases of TRAPS, 37 cases of prenatal ultrasound examinations at 8-11 weeks of gestation were retrospectively analyzed, and 42 cases of monochorionic twin pregnancies in early pregnancy with no obvious structural abnormalities in prenatal ultrasound system examination and postpartum follow-up were collected as the control group. Summarized the ultrasound characteristics and counted the difference in the number of days corresponding to the gestational week size of the two fetuses in the first trimester and the difference in embryo length separately, and the receiver operating curve (ROC) was used to evaluate the predictive value of TRAPS in the first trimester. Results 1. Among 37 cases of TRAPS, 36 cases were twin pregnancy, 1 case was triple pregnancy, 42 cases in normal group were twin pregnancy. 2. 37 cases of TRAPPS in the larger embryos were visible normal cardiac throbbing, 34 cases of smaller embryos did not see obvious cardiac throbbing, 3 cases of visible cardiac throbbing, 42 cases of control group double fetuses were visible normal heart tube throbbing.3 .There was no significant difference in the age of the two groups of patients and the clinical gestational weeks of the two fetuses (P>0.05); the difference in ultrasound gestational weeks between the two fetuses in the study group and the control group was 9.1±6.9 days and 1.6±1.5 days, respectively. The results of the two groups were statistically different (P<0.05); the difference in embryo length between the study group and the control group was 10.3±7.7mm and 1.9±1.9mm, respectively, and the results of the two groups were statistically different (P<0.05). 4. Using the receiver operating curve (ROC) analysis, when the difference between two embryos is more than 5 days and the length of two embryos is more than 4.5 mm as the cut-off value for diagnosis of TRAPS, the area under the curve, sensitivity, specificity, the positive predictive value and negative predictive value were 0.65 vs 0.66, 67.6% vs 75.7%, 97.6% vs 97.5%, 92.3% vs 87.8%, and 77.3% vs 82.2%, respectively. Conclusion The uncoordinated growth and development of twin fetuses and the absence of significant cardiac throbbing in one of the embryos were of high value to predict the occurrence of TRAPS during 8-11 weeks of early pregnancy. |
| Key words: prenatal ultrasound diagnosis early pregnancy twin reversed arterial perfusion sequence |
