使用心肌性能指数评估双胎输血综合征宫内治疗的疗效。
Evaluation of the efficacy of intrauterine treatments of twin-to-twin transfusion syndrome using myocardial performance index.
作者信息
Jiang Yu, Qiao Xiaoyong, Liao Hua, Luo Hong
机构信息
Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Quant Imaging Med Surg. 2024 Aug 1;14(8):5621-5629. doi: 10.21037/qims-23-1669. Epub 2024 Jul 26.
BACKGROUND
Prognosis of twin-to-twin transfusion syndrome (TTTS) varies depending on the Quintero stage and fetal cardiac function. The purpose of our study was to evaluate fetal cardiac function before and after different intrauterine treatments of TTTS through myocardial performance index (MPI).
METHODS
In this retrospective study, data were collected from August 2016 to December 2022. Totals of 68 cases of TTTS and 68 monochorionic diamniotic (MCDA) twins without TTTS were included. MPI was collected and compared between TTTS and MCDA twins without TTTS before intrauterine treatments. TTTS cases were divided into 3 groups according to different intrauterine treatments: (I) amnioreduction (34 cases), (II) fetoscopic laser photocoagulation (FLPC; 20 cases), and (III) selective reduction (14 cases). The MPI of the left ventricle (LV) and right ventricle (RV) in each surviving fetus were measured 48 hours before and after treatments by pulse Doppler ultrasound. One-way analysis of variance (ANOVA) was employed to assess whether there were statistical differences in LV-MPI and RV-MPI among the donors, recipients, and the control group. Paired -test analysis was used to compare whether there were differences in MPI before and after intrauterine treatments.
RESULTS
The MPIs of the LV and RV in the recipients were significantly higher than those in the MCDA twins without TTTS (P<0.05). After the amnioreduction treatment of TTTS, no significant differences were observed in the MPI of either the LV or the RV before and after treatment. At 48 hours after FLPC treatment, the value of the LV-MPI in donors was 0.25±0.08, and the value of the RV-MPI in recipients was 0.58±0.17. Both of them were significantly lower than those before the treatment (P<0.05). In the selective reduction group, the value of the RV-MPI in surviving recipients significantly decreased compared to that before treatment (P<0.05).
CONCLUSIONS
MPI is an effective indicator to evaluate fetal cardiac function of TTTS and assess the efficacy of intrauterine treatments of TTTS.
背景
双胎输血综合征（TTTS）的预后因Quintero分期和胎儿心功能而异。我们研究的目的是通过心肌性能指数（MPI）评估TTTS不同宫内治疗前后的胎儿心功能。
方法
在这项回顾性研究中，收集了2016年8月至2022年12月的数据。纳入了68例TTTS病例和68例无TTTS的单绒毛膜双羊膜囊（MCDA）双胎。在宫内治疗前，收集并比较TTTS双胎和无TTTS的MCDA双胎的MPI。TTTS病例根据不同的宫内治疗分为3组：（I）羊水减量术（34例），（II）胎儿镜激光凝固术（FLPC；20例），以及（III）选择性减胎术（14例）。通过脉冲多普勒超声在治疗前后48小时测量每个存活胎儿左心室（LV）和右心室（RV）的MPI。采用单因素方差分析（ANOVA）评估供体、受体和对照组之间LV-MPI和RV-MPI是否存在统计学差异。配对检验分析用于比较宫内治疗前后MPI是否存在差异。
结果
受体中LV和RV的MPI显著高于无TTTS的MCDA双胎（P<0.05）。TTTS羊水减量治疗后，LV或RV的MPI治疗前后均未观察到显著差异。FLPC治疗后48小时，供体中LV-MPI的值为0.25±0.08，受体中RV-MPI的值为0.58±0.17。两者均显著低于治疗前（P<0.05）。在选择性减胎组中，存活受体的RV-MPI值与治疗前相比显著降低（P<0.05）。
结论
MPI是评估TTTS胎儿心功能和评估TTTS宫内治疗疗效的有效指标。
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