新生儿双胎输血综合征的临床研究

Clinical study of neonatal twin-twin transfusion syndrome

摘要:

目的 探讨不同分级、不同宫内干预和不同血流供输结果双胎输血综合征(twin-twin transfusion syndrome, TTTS)患儿的临床表现及近期预后。方法 对76例新生儿病房住院的TTTS患儿的住院病案资料进行回顾性研究。将入选对象按以下3种方法分组：(1)按照TTTS分级分为轻度TTTS组(n=38)和重度TTTS组(n=21); (2)按照不同宫内干预方法分为羊水减量组(n=20)、激光治疗组(n=21)和期待治疗组(n=32); (3)按照输血对象分为供血儿组(n=23)和受血儿组(n=30)。结果 重度TTTS组脑损伤、心脏病变、生后窒息、肾功能损害的发生率和住院期间病死率均高于轻度TTTS组, 但差异无统计学意义。激光治疗组脑损伤、心脏病变、肾功能损害的发生率和住院期间病死率有低于羊水减量组和期待治疗组的趋势。受血儿组心脏病变和病理性黄疸的发生率高于供血儿组, 差异有统计学意义(P<0.05)。供血儿组生后窒息和肾功能损害的发生率高于受血儿组, 但差异无统计学意义。结论 TTTS分级高者器官损伤发生率和住院期间病死率相对高。激光治疗较期待治疗和羊水减量治疗的TTTS患儿的预后可能更佳。受血儿更易发生心脏病变、病理性黄疸, 供血儿发生生后窒息和肾脏损害的倾向高于受血儿。

Abstract:

Objective To explore the clinical manifestations and short-term prognosis of twin-twin transfusion syndrome (TTTS) in neonates with different disease stages, receiving different intrauterine interventions, or as blood donors and recipients. Methods The study retrospectively collected 76 TTTS neonates who were hospitalized in the Neonatal Ward, Peking University Third Hospital. The participants were classified into mild TTTS (n=38) and severe TTTS groups (n=21), or into amnioreduction (n=20), laser surgery (n=21), and expectant therapy groups (n=32), or into donor (n=23) and recipient groups (n=30). Results The severe TTTS group had higher incidences of brain injury, heart disease, asphyxia, and renal damage and in-hospital mortality rate compared with the mild TTTS group, but the differences had no statistical significance. The laser surgery group displayed decreasing trends in the incidences of brain injury, heart disease, and renal damage and in-hospital mortality rate compared with the amnioreduction and expectant therapy groups. The recipient group had higher incidences of heart diseases and pathological jaundice than the donor group (P<0.05). The donor group had higher incidences of asphyxia and renal damage than the recipient group, but with no significant difference. Conclusions The neonates with severe TTTS have higher rates of organ damages and in-hospital mortality. Intrauterine laser surgery seems to lead to a better prognosis compared with the amnioreduction and expectant therapy. The recipients are more susceptible to heart diseases and pathological jaundice, whereas the donors are more susceptible to asphyxia and renal damage.