双胎输血综合征合并镜像综合征引产一例

doi:10.12280/gjfckx.20210005

摘要/Abstract

摘要：

镜像综合征又称巴兰坦综合征,主要表现为胎儿、胎盘水肿和继发性母体不同程度的水肿及血液稀释的临床特点。镜像综合征发病率极低,病情进展快,国内外报道例数较少,目前其病因大多与诱发胎儿水肿的因素相关,其中双胎输血综合征是胎儿非免疫性水肿病因之一。回顾南京医科大学附属第一医院2019年2月收治的双胎输血综合征合并镜像综合征的病例,分析患者的一般情况,并予以合理治疗干预,分析预后情况。该患者在入院保守治疗的情况下病情加重,最终选择终止妊娠,妊娠终止后病情较前明显好转,予以出院门诊随访。现对其诊断、鉴别诊断和治疗方式进行讨论。

关键词: 镜像综合征, 双胎输血综合征, 高血压,妊娠性, 引产, 病例报告

Abstract:

Mirror syndrome, also known as Ballantyne syndrome, is characterized by fetal and placental edema, secondary maternal edema and hemodilution. The incidence rate of mirror syndrome is extremely low, the disease progresses rapidly, and the number of reported cases is relatively small at home and abroad. The etiology is mostly related to the factors inducing fetal edema. Twin-twin transfusion syndrome is one of the causes of fetal nonimmune edema. This article reviews the cases of twin-twin transfusion syndrome combined with mirror syndrome in the First Affililated Hospital of Nanjing Medical University in February 2019, analyzes the general situation of the patients, gives reasonable treatment intervention, and analyzes the prognosis. In the case, the patient′s condition worsened under the condition of conservative treatment, and finally chose to terminate the pregnancy. After the termination of pregnancy, the patient′s condition improved significantly, and was discharged from the outpatient clinic for follow-up. The diagnosis, differential diagnosis and treatment were discussed.

Key words: Mirror syndrome, Fetofetal transfusion, Hypertension,pregnancy-induced, Labor,induced, Case reports

唐晓彤, 葛志平. 双胎输血综合征合并镜像综合征引产一例[J]. 国际妇产科学杂志, 2021, 48(5): 521-524.

TANG Xiao-tong, GE Zhi-ping. Twin-Twin Transfusion Syndrome with Mirror Syndrome Induced Labor: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2021, 48(5): 521-524.

图/表 7

图1 胎儿第一层次超声注：胎儿一腹腔积液,大小32 mm×34 mm（黑箭头）。

图2 胎儿心脏超声注：胎儿心脏内探及二、三尖瓣瓣口重度反流信号（白箭头）;胎儿心包腔积液（黑箭头）。

图3 双死胎和胎盘注：左侧为供血儿,右侧为受血儿。

图4 镜像综合征胎盘大体表现

图5 胎盘脐带病理图片（HE×200）注：部分绒毛间质明显水肿,脐带间质见水肿变性。

表1 患者住院期间实验室检查结果

指标	13日	14日	15日	16日产后	17日	18日	21日
Hb（g/L）	96	99	100	80	74	73	72
HCT（%）	27.5	27.1	28.6	22.8	21.1	20.7	21.3
白蛋白（g/L）	21.0	-	-	-	16.5	20.3	25.5
尿酸（μmol/L）	496	-	-	-	563	-	353
hCG（IU/L）	-	>269 800	-	-	28 076	6 592	-

表2 住院期间患者出入量、体质量的变化

指标	13日	14日	15日	16日产后	17日	18日	19日	20日
入量（mL）	760	1 600	1 000	3 383	1 260	1 983	1 900	2 300
出量（mL）	650	1 000	1 720	3 500	1 645	2 850	3 700	3 400
体质量（kg）	67	68.5	70	卧床	62	61	60	57

参考文献 15

[1]	Mathias CR, Rizvi C. The diagnostic conundrum of maternal mirror syndrome progressing to pre-eclampsia-A case report[J]. Case Rep Womens Health, 2019,23:e00122. doi: 10.1016/j.crwh.2019.e00122. doi: 10.1016/j.crwh.2019.e00122
[2]	Chimenea A, García-Díaz L, Calderón AM, et al. Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series[J]. BMC Pregnancy Childbirth, 2018,18(1):85. doi: 10.1186/s12884-018-1718-0. doi: 10.1186/s12884-018-1718-0
[3]	田晓予, 杨雪. 巨大胎盘绒毛膜血管瘤合并镜像综合征一例并文献复习[J]. 国际妇产科学杂志, 2020,47(3):291-293. doi. 10.3969/j.issn.1674-1870.2020.03.011. doi: 10.3969/j.issn.1674-1870.2020.03.011
[4]	Lee JY, Hwang JY. Mirror syndrome associated with fetal leukemia[J]. J Obstet Gynaecol Res, 2015,41(6):971-974. doi: 10.1111/jog.12654. doi: 10.1111/jog.12654
[5]	Bamberg C, Hecher K. Update on twin-to-twin transfusion syndrome[J]. Best Pract Res Clin Obstet Gynaecol, 2019,58:55-65. doi: 10.1016/j.bpobgyn.2018.12.011. doi: 10.1016/j.bpobgyn.2018.12.011
[6]	Allarakia S, Khayat HA, Karami MM, et al. Characteristics and management of mirror syndrome: a systematic review (1956-2016)[J]. J Perinat Med, 2017,45(9):1013-1021. doi: 10.1515/jpm-2016-0422. doi: 10.1515/jpm-2016-0422 pmid: 28315852
[7]	钟立航, 王谢桐. 胎儿非免疫水肿的诊断和处理[J]. 实用妇产科杂志, 2020,36(3):176-179.
[8]	邱丽茵, 潘勉, 张荣莲, 等. 镜像综合征六例临床分析[J]. 中华妇产科杂志, 2017,52(3):184-186. doi: 10.3760/cma.j.issn.0529-567x.2017.03.008. doi: 10.3760/cma.j.issn.0529-567x.2017.03.008
[9]	刘慧, 张华, 童笑梅. 非免疫性胎儿水肿新生儿的临床特征及预后分析[J]. 中国当代儿科杂志, 2019,21(3):253-258. doi: 10.7499/j.issn.1008-8830.2019.03.013. doi: 10.7499/j.issn.1008-8830.2019.03.013
[10]	Greimel P, Zenz A, Csapó B, et al. Maternal Complications and Hemodynamic Changes Following Intrauterine Interventions for Twin-to-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies[J]. J Clin Med, 2019,8(5):605. doi: 10.3390/jcm8050605. doi: 10.3390/jcm8050605
[11]	Bartnik P, Kacperczyk-Bartnik J, Malinowska-Polubiec A, et al. Mirror Syndrome with Severe Postpartum Presentation following Stillbirth and Shoulder Dystocia[J]. Fetal Pediatr Pathol, 2020,39(5):441-445. doi: 10.1080/15513815.2019.1658246. doi: 10.1080/15513815.2019.1658246
[12]	Katoh Y, Seyama T, Mimura N, et al. Elevation of maternal serum sFlt-1 in pregnancy with mirror syndrome caused by fetal cardiac failure[J]. Oxf Med Case Reports, 2018,2018(3):omx112. doi: 10.1093/omcr/omx112. doi: 10.1093/omcr/omx112
[13]	叶彩霞, 石雅莉, 王丽, 等. 双绒毛膜双羊膜囊双胎之一巴氏水肿儿并母胎镜像综合征1例报道[J]. 中国产前诊断杂志(电子版), 2018,10(2):43-45. doi: 10.13470/j.cnki.cjpd.2018.02.011. doi: 10.13470/j.cnki.cjpd.2018.02.011
[14]	Nassr AA, Shamshirsaz AA, Belfort MA, et al. Spontaneous resolution of mirror syndrome following fetal interventions for fetal anemia as a consequence of twin to twin transfusion syndrome[J]. Eur J Obstet Gynecol Reprod Biol, 2017,208:110-111. doi: 10.1016/j.ejogrb.2016.11.023. doi: 10.1016/j.ejogrb.2016.11.023
[15]	Okby R, Mazor M, Erez O, et al. Reversal of mirror syndrome after selective feticide of a hydropic fetus in a dichorionic diamniotic twin pregnancy[J]. J Ultrasound Med, 2015,34(2):351-353. doi: 10.7863/ultra.34.2.351. doi: 10.7863/ultra.34.2.351