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目的探讨单绒毛膜(MC)双胎选择性宫内生长受限(s IUGR)对新生儿脑损伤的影响。方法选择2011年6月至2014年6月在暨南大学第二临床医学院就诊及分娩的MC双胎并发s IUGR产妇24例和其48个胎儿为s IUGR组,并根据s IUGR儿脐动脉血流多普勒波形将s IUGR组分为Ⅰ型11例、Ⅱ型10例、Ⅲ型3例。同期分娩的无并发症的MC双胎56例及其112个胎儿作为对照组。分娩后对新生儿头颅进行超声检查,如有异常则用超声或磁共振(MRI)复查,随访至新生儿出院。新生儿脑损伤分为轻度:(1)Ⅰ级、Ⅱ级脑室内出血(IVH)。(2)豆状核纹状体血管病变和(或)室管膜下假性囊肿。重度:(1)Ⅲ、Ⅳ级IVH。(2)Ⅱ级以上脑室周围白质软化囊性变(PVL)。(3)脑穿通囊肿和(或)脑室扩张。分析比较两组及3种类型s IUGR之间新生儿结局及脑损伤情况。结果 s IUGR组新生儿重度、轻度脑损伤率分别为(4.2%,1/24)、(10.4%,5/48);而对照组分别为(0)、(6.2%,7/112)。两组比较差异无统计学意义(P>0.05)。轻度脑损伤12例,均无明显神经系统受损的临床表现,其中11例(11/12,91.7%)复查头颅超声或MRI见影像学明显改善。s IUGR组Ⅰ型有2例(2/22,9.1%)而Ⅱ、Ⅲ型有3例(3/26,11.5%)出现轻度脑损伤,两两比较,差异无统计学意义(P>0.05)。s IUGR组Ⅱ、Ⅲ型各有1例新生儿死亡及1例重度脑损伤,而s IUGRⅠ型无新生儿死亡和重度脑损伤,虽然差异未达统计学意义(P>0.05),但其预后明显差于Ⅰ型。结论与正常MC双胎比较,MC双胎并发s IUGR新生儿近期重度、轻度脑损伤发生率无明显差异,且绝大多数轻度脑损伤为暂时性,但s IUGRⅡ、Ⅲ型比Ⅰ型预后差,应加强监测,适时终止妊娠。
Objective To investigate the effect of monoepithelial (MC) twins selective intrauterine growth restriction (s IUGR) on neonatal brain injury. Methods From June 2011 to June 2014, 24 pregnant women with MC twins who were seen and delivered at the Second Clinical College of Jinan University from January 2011 to June 2014 were enrolled in this study and their 48 fetuses were classified as sUUU. Flow-Doppler waveforms of s IUGR were classified as type Ⅰ in 11 cases, type Ⅱ in 10 cases and type Ⅲ in 3 cases. Fifty-six cases of uncomplicated MC twins and 112 fetuses were given as control group. After delivery, neonatal skull ultrasound examination, if abnormal, ultrasound or magnetic resonance (MRI) review, follow-up to the newborn discharged. Neonatal brain injury is divided into mild: (1) grade Ⅰ, Ⅱ intraventricular hemorrhage (IVH). (2) lentiform nucleus vascular lesions and (or) subependymal pseudocyst. Severe: (1) Ⅲ, Ⅳ grade IVH. (2) Class Ⅱ or more periventricular white matter cystic degeneration (PVL). (3) brain through the cyst and (or) ventricular dilatation. Analysis and comparison of neonatal outcomes and brain injury between two groups and three types of IUGR. Results The rates of severe and mild brain injury in sIUGR group were (4.2%, 1/24) and (10.4%, 5/48), respectively, while those in control group were (0) and . There was no significant difference between the two groups (P> 0.05). There were no obvious clinical manifestations of nervous system damage in 12 cases with mild brain injury. Eleven (11 / 12,91.7%) patients had recheck skull ultrasound or MRI, and the imaging findings were significantly improved. There were 2 cases (2 / 22,9.1%) of type Ⅰ in IUGR group and 3 cases (3 / 26,11.5%) in type Ⅱ and Ⅲ. There was no significant difference between any two groups (P> 0.05). s There were 1 neonatal death and 1 severe brain injury in IUGR group Ⅱ and Ⅲ, respectively. There was no significant difference in sIUGR Ⅰ death or severe brain injury between the two groups (P> 0.05) Obviously worse than type Ⅰ. Conclusion Compared with normal MC twins, there is no significant difference in recent severe and mild brain injury among MC twins with newborn sIUGR, and the majority of mild brain injury is temporary. However, sIUGRⅡ and Ⅲ are more severe than those of type Ⅰ Poor prognosis, should be strengthened monitoring, timely termination of pregnancy.