激光治疗双胎输血综合征后神经发育结局的系统评价和荟萃分析。

Neurodevelopmental outcomes after laser therapy for twin-twin transfusion syndrome: a systematic review and meta-analysis.

机构信息

From the Clinic of Obstetrics and Gynecology, San Giacomo Hospital, Monopoli, Bari, Italy; and the Division of General Pediatrics, Department of Pediatrics, Division of Maternal-Fetal Medicine, and the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.

出版信息

Obstet Gynecol. 2011 Nov;118(5):1145-1150. doi: 10.1097/AOG.0b013e318231827f.

DOI:10.1097/AOG.0b013e318231827f

PMID:22015883

Abstract

OBJECTIVE

To perform a systematic review of the literature regarding the occurrence of neurologic morbidity, neurologic impairment, or neurologic morbidity and impairment of patients treated with laser therapy for twin-twin transfusion syndrome.

DATA SOURCES

The PubMed, MEDLINE, EMBASE databases and reference lists were searched up to December 2010 for studies describing outcomes in laser-treated twin-twin transfusion syndrome pregnancies. METHODS FOR STUDY SELECTION: Inclusion criteria were twin-twin transfusion syndrome diagnosed with standard criteria and treated by laser therapy and neurologic morbidity and neurologic impairment collected at birth or 28 days after birth. Exclusion criteria were omission of at least one criterion; data in graphs or percentage; and non-English publications, letters, personal communications.

TABULATION, INTEGRATION AND RESULTS: Data recorded were rates and length of successful follow-up, age at diagnosis and type of neurologic morbidity, affected donors and recipients, prevalence of neurologic morbidity, and neurologic impairment for twin sets. From 15 articles, the incidence of neurologic morbidity at birth was 55 out of 895 (6.1%), without differences between donors and recipients (19/249, 7.6% compared with 16/273, 5.8%; odds ratio [OR] 1.36; 95% confidence interval [CI] 0.68-2.70). At follow-up, the incidence of neurologic impairment was 140 out of 1,255 (11.1%), with cerebral palsy the most frequent (60/151, 39.7%). Neurologic impairment was identified equally between donors and recipients (48/330, 14.5% compared with 54/364, 14.8%; OR 1.02; 95% CI 0.66-1.57), and between one survivor and two survivors for twin sets (24/139, 17.3% compared with 88/489, 18.0%; OR 0.67; 95% CI 0.18-2.49).

CONCLUSION

A small number (11.1%) of cases of twin-twin transfusion syndrome treated with laser therapy are affected with neurologic impairment that manifests during infancy. A strict follow-up of apparently healthy neonates is warranted.

摘要

目的

系统回顾激光治疗双胎输血综合征患者的神经发病率、神经损伤或神经发病率和损伤的文献。

数据来源

截至 2010 年 12 月，检索了 PubMed、MEDLINE、EMBASE 数据库和参考文献列表，以查找描述激光治疗双胎输血综合征妊娠结局的研究。

研究选择方法

纳入标准为采用标准标准诊断的双胎输血综合征，并接受激光治疗，出生或出生后 28 天收集神经发病率和神经损伤。排除标准为至少遗漏一个标准；数据在图表或百分比中；以及非英文出版物、信件、个人通讯。

数据记录

记录的资料包括成功率和随访时间、诊断年龄和神经发病率类型、受影响的供体和受体、神经发病率的发生率以及双胞胎的神经损伤。从 15 篇文章中，出生时的神经发病率为 895 例中的 55 例（6.1%），供体和受体之间无差异（249 例中的 19 例，7.6%，与 273 例中的 16 例，5.8%；比值比[OR]1.36；95%置信区间[CI]0.68-2.70）。在随访期间，神经损伤的发生率为 1255 例中的 140 例（11.1%），脑瘫最常见（151 例中的 60 例，39.7%）。神经损伤在供体和受体之间同样被识别（330 例中的 48 例，14.5%，与 364 例中的 54 例，14.8%；OR 1.02；95%置信区间[CI]0.66-1.57），以及在双胞胎中一个幸存者和两个幸存者之间（139 例中的 24 例，17.3%，与 489 例中的 88 例，18.0%；OR 0.67；95%置信区间[CI]0.18-2.49）。