CAJ | 학술논문

目的：通过超声评价单绒毛膜双羊膜囊（MCDA）双胎选择性宫内生长受限（sIUGR）胎儿心功能，为临床抉择及手术时机选择提供参考。方法选择2013年12月至2014年9月在中山大学附属第一医院医学中心确诊 sIUGR 之初的孕妇24例，平均年龄28岁，中位孕周22周（18~26周）；选择同期同医院正常MCDA 双胎孕妇20例，平均年龄31岁，中位孕周27周（19~34周）。超声测量脐动脉（UA）、脐静脉（UV）、静脉导管血流频谱及静脉导管搏动指数（DV-PI）、房室瓣及半月瓣血流频谱、三尖瓣环收缩期位移（TAPSE）、左心室短轴缩短率（FS）、左右心室 Tei 指数，比较 sIUGR 大小胎间心功能及正常 MCDA 双胎间心功能。结果正常 MCDA 双胎在心率、DV-PI、心胸面积比、FS、TAPSE、左心室 Tei 指数（分别为0.34±0.03、0.34±0.04）、右心室 Tei 指数（分别为0.35±0.03、0.35±0.03）比较，差异均无统计学意义（P 均﹥0.05）。sIUGR 大胎心胸面积比、室壁厚度、等容舒张时间（IRT）、等容收缩时间（ICT）、TAPSE、三尖瓣反流均高于小胎，差异均有统计学意义（P 均﹤0.05），左右心室 Tei 指数高于小胎（大小胎左心室 Tei 指数分别为0.43±0.06、0.35±0.04，右心室 Tei 指数分别为0.43±0.06、0.34±0.04，P ﹤0.05），二、三尖瓣舒张早晚期血流峰值比值（E/ A）及二、三尖瓣舒张期血流充盈时间占心动周期百分比（ inflow/ CCL）低于小胎，差异均有统计学意义（P 均﹤0.05）。结论正常 MCDA 双胎间心脏收缩舒张功能差异无统计学意义，sIUGR 初诊时大胎心脏已有舒张功能异常，监测胎儿心功能状况可为临床干预提供参考。
목적：통과초성평개단융모막쌍양막낭（MCDA）쌍태선택성궁내생장수한（sIUGR）태인심공능，위림상결택급수술시궤선택제공삼고。방법선택2013년12월지2014년9월재중산대학부속제일의원의학중심학진 sIUGR 지초적잉부24례，평균년령28세，중위잉주22주（18~26주）；선택동기동의원정상MCDA 쌍태잉부20례，평균년령31세，중위잉주27주（19~34주）。초성측량제동맥（UA）、제정맥（UV）、정맥도관혈류빈보급정맥도관박동지수（DV-PI）、방실판급반월판혈류빈보、삼첨판배수축기위이（TAPSE）、좌심실단축축단솔（FS）、좌우심실 Tei 지수，비교 sIUGR 대소태간심공능급정상 MCDA 쌍태간심공능。결과정상 MCDA 쌍태재심솔、DV-PI、심흉면적비、FS、TAPSE、좌심실 Tei 지수（분별위0.34±0.03、0.34±0.04）、우심실 Tei 지수（분별위0.35±0.03、0.35±0.03）비교，차이균무통계학의의（P 균﹥0.05）。sIUGR 대태심흉면적비、실벽후도、등용서장시간（IRT）、등용수축시간（ICT）、TAPSE、삼첨판반류균고우소태，차이균유통계학의의（P 균﹤0.05），좌우심실 Tei 지수고우소태（대소태좌심실 Tei 지수분별위0.43±0.06、0.35±0.04，우심실 Tei 지수분별위0.43±0.06、0.34±0.04，P ﹤0.05），이、삼첨판서장조만기혈류봉치비치（E/ A）급이、삼첨판서장기혈류충영시간점심동주기백분비（ inflow/ CCL）저우소태，차이균유통계학의의（P 균﹤0.05）。결론정상 MCDA 쌍태간심장수축서장공능차이무통계학의의，sIUGR 초진시대태심장이유서장공능이상，감측태인심공능상황가위림상간예제공삼고。
Objective To evaluate the fetal cardiovascular function in selective intrauterine growth restriction (sIUGR)in monochorionic diamniotic(MCDA)twins by using 2D and color Doppler ultrasonography. Methods Twenty - four sIUGR pregnancies and 20 normal MCDA twins pregnancies were enrolled at the First Affiliated Hospital of Sun Yat - Sen University from December 2013 to September 2014,and cardiac structure of fetus and Doppler patterns of the umbilical artery(UA),umbilical vein(UV),pulsatility index of ductus venosus(DV - PI),atrioventricular valve, semilunar valve,tricuspid annulus systolic displacement(TAPSE),fractional shortening of left ventricle short axis(FS) and myocardial performance index(Tei index)of both ventricles were assessed. Results Cardiothoracic ratio,heart rate,DV - PI,FS,TAPSE,Tei index of the left ventricle(0. 34 ± 0. 03,0. 34 ± 0. 04),Tei index of the right ventricle (0. 35 ± 0. 03,0. 35 ± 0. 03)were not significantly different compared with those of the normal MCDA twins(all P ﹥0. 05). Cardiothoracic ratio,ventricular wall thickness,isovolumetric relaxation time( IRT),isovolumetric contraction time(ICT),TAPSE and tricuspid regurgitation(TR)in the larger twins of sIUGR were significantly bigger than those in the smaller twins of sIUGR(all P ﹤ 0. 05),Tei index of both ventricles in the larger twin of sIUGR was significantly higher than that in the smaller twins of sIUGR(Tei index of left ventricle:0. 43 ± 0. 06 vs 0. 35 ± 0. 04,Tei index of right ventricle:0. 43 ± 0. 06 vs 0. 34 ± 0. 04,P ﹤ 0. 05),the peak E in early diastolic / the peak A in atrial contraction (E/ A),the percentage of inflow during of cardiac cycle length(inflow/ CCL)in larger twin of sIUGR were significantly lower than those in smaller twin of sIUGR(all P ﹤ 0. 05). Conclusions There was no difference of cardiac function in normal MCDA twins,at the beginning of the diagnosis of sIUGR,cardiac dysfunction were found in larger twin,follow -up examination are helpful to clinical decision.