Yamamoto M, Essaoui M, Nasr B, Malek N, Takahashi Y, Moreira de Sa R, Ville Y
Service de Gynécologie Obstétrique, CHI Poissy Saint Germain en Laye, Université de Paris-Ouest Versailles-St. Quentin en Yvelines, Poissy, France.
Ultrasound Obstet Gynecol. 2007 Dec;30(7):972-6. doi: 10.1002/uog.5218.
Fetal urine production in twin-to-twin transfusion syndrome (TTTS) reflects the hemodynamic imbalance between the donor and recipient twins but it has not been measured in this particular condition. The aim of this study was to measure fetal urine production using three-dimensional (3D) ultrasound in donor and recipient twins before and after laser treatment for TTTS and to correlate this with umbilical venous volume flow (UVVF).
Urine production rate (UPR) was measured using 3D ultrasound with Virtual Organ Computer-aided AnaLysis (VOCAL) in 106 cases of severe TTTS. The rotation angle was set at 30 degrees . The bladder volume was measured twice in each fetus (V(1) and V(2)), with an interval of 5-30 min between measurements, in order to calculate the UPR. When V(2) > V(1), UPR was calculated using the formula: V(2) - V(1) /time interval. Together with UPR, UVVF was measured before and after treatment. Both parameters were corrected for fetal weight. Inter- and intraobserver variability were calculated in 16 cases using the intraclass correlation coefficient.
Before laser treatment, UPR was significantly higher in recipients compared with donors (median, 14.8 and 0 mL/h/kg, mean 23.8 and 2.3 mL/h/kg, respectively, P < 0.001), and UPR was positively correlated with UVVF in both twins. Following laser treatment (48 h later), UPR decreased to 9 mL/h/kg (P < 0.001) in recipients, while there was no change in donors. UVVF increased significantly from a median value of 92 to 132 mL/min/kg (P < 0.01) in donors and decreased significantly from 150 to 99 mL/min/kg (P < 0.001) in recipients.
In TTTS UPR is correlated to UVVF and reflects the hemodynamic imbalance between donor and recipient twins. Following laser treatment, UPR decreases in recipients but is unaffected in donors. However, changes in UVVF occur in both twins. This suggests that although fetal renal function is driven by fetal hemodynamics, there may be a lag in the recovery of renal function in the donor twin.
双胎输血综合征（TTTS）中胎儿尿液生成反映了供血儿与受血儿之间的血流动力学失衡，但尚未在这种特殊情况下进行测量。本研究的目的是在TTTS激光治疗前后，使用三维（3D）超声测量供血儿与受血儿的胎儿尿液生成，并将其与脐静脉容积流量（UVVF）相关联。
采用虚拟器官计算机辅助分析（VOCAL）的3D超声测量106例重度TTTS患者的尿液生成率（UPR）。旋转角度设定为30度。在每个胎儿中测量膀胱容积两次（V(1)和V(2)），测量间隔为5 - 30分钟，以计算UPR。当V(2)>V(1)时，使用公式：(V(2) - V(1))/时间间隔计算UPR。与UPR一起，在治疗前后测量UVVF。两个参数均根据胎儿体重进行校正。使用组内相关系数在16例病例中计算观察者间和观察者内的变异性。
激光治疗前，受血儿的UPR显著高于供血儿（中位数分别为14.8和0 mL/h/kg，平均值分别为23.8和2.3 mL/h/kg，P<0.001），并且在两个胎儿中UPR均与UVVF呈正相关。激光治疗后（48小时后），受血儿的UPR降至9 mL/h/kg（P<0.001），而供血儿无变化。供血儿的UVVF从中位数92显著增加至132 mL/min/kg（P<0.01），受血儿则从150显著降至99 mL/min/kg（P<0.001）。
在TTTS中，UPR与UVVF相关，并反映了供血儿与受血儿之间的血流动力学失衡。激光治疗后，受血儿的UPR降低，但供血儿不受影响。然而，两个胎儿的UVVF均发生变化。这表明尽管胎儿肾功能受胎儿血流动力学驱动，但供血儿的肾功能恢复可能存在滞后。
