2025 , Vol. 22 >Issue 05: 462 - 469
DOI: https://doi.org/10.3877/cma.j.issn.1672-6448.2025.05.012
双胎贫血-红细胞增多序列征的产前超声特征分析
Copy editor: 吴春凤
收稿日期: 2025-02-18
网络出版日期: 2025-07-17
基金资助
重庆市科卫联合医学科研项目（2025MSXM010）
版权
Prenatal ultrasonographic features of twin anemia-polycythemia sequence: analysis of 26 cases
Received date: 2025-02-18
Online published: 2025-07-17
Copyright
目的
探讨双胎贫血-红细胞增多序列征（TAPS）的产前超声特征及预后。
方法
回顾性分析2017 年7 月至2024 年12 月在重庆医科大学附属妇女儿童医院行超声检查诊断为TAPS的26 例病例的产前超声特征、治疗方式及妊娠结局。
结果
26 例均为单绒毛膜双胎，诊断为原发性TAPS。共有的产前超声特征为：（1）供血儿大脑中动脉峰值流速（MCA-PSV）＞1.5 中位数倍数（MoM），受血儿MCA-PSV＜1.0 MoM；（2）“黑白”胎盘。其他超声特征包括：（1）受血儿肝呈“星空征”；（2）供血儿肠道回声增强；（3）心脏异常；（4）多普勒血流指标异常；（5）胎儿水肿；（6）脐带异常；（7）羊水量不均衡；（8）合并选择性宫内生长受限、双胎输血综合征等。26 例中，13例选择射频消融减胎术（存活率92%），5 例选择胎儿镜下胎盘血管交通支凝固术（存活率100%），7例选择期待治疗（存活率64%），1 例引产。
结论
单绒毛膜双胎在超声检查时需要特别关注胎儿多普勒血流指标、胎盘情况、肝及肠道回声等。没有行宫内治疗的TAPS 双胎预后相对差，一旦诊断TAPS，建议转诊到有宫内治疗条件的三级产前诊断中心诊治。
关键词： 单绒毛膜双胎; 双胎贫血-红细胞增多序列征; 产前超声; 宫内治疗
王彦 , 张晓航 , 冉素真 , 钟春燕 , 张晋炜 , 王希 . 双胎贫血-红细胞增多序列征的产前超声特征分析[J]. 中华医学超声杂志（电子版）, 2025 , 22(05) : 462 -469 . DOI: 10.3877/cma.j.issn.1672-6448.2025.05.012
Objective
To explore the prenatal ultrasound features and prognosis of twin anemiapolycythemia sequence (TAPS).
Methods
A retrospective analysis was conducted on 26 twins diagnosed with TAPS by prenatal ultrasound at the Women and Children’s Hospital of Chongqing Medical University from July 2017 to December 2024, focusing on their prenatal ultrasound features, treatment methods, and pregnancy outcomes.
Results
All 26 cases were monochorionic twins, and all were diagnosed with primary TAPS.Common prenatal ultrasound features included: (1) peak systolic velocity of the middle cerebral artery (MCA-PSV) > 1.5 multiples of the median (MoM) in the donor twin and < 1.0 MoM in the recipient twin; and (2) “black and white” placenta.Other ultrasound features included: (1) “starry sky” sign in the recipient twin’s liver; (2) enhanced intestinal echogenicity in the donor twin; (3) cardiac abnormalities;(4) abnormal Doppler blood flow indices; (5) fetal hydrops; (6) umbilical cord abnormalities; (7) uneven amniotic fluid volume; and (8) coexisting selective intrauterine growth restriction, twin to twin transfusion syndrome, etc.Among the 26 cases, 13 underwent radiofrequency ablation for fetal reduction (survival rate 92%), 5 underwent fetoscopic coagulation of placental vascular anastomoses (survival rate 100%), 7 received expectant management (survival rate 64%), and 1 underwent induced labor.
Conclusion
In ultrasound examinations of monochorionic twins, special attention should be paid to fetal Doppler blood flow indicators,placental conditions, liver and intestinal tract echoes, etc.The prognosis of TAPS twins without intrauterine treatment is relatively poor.Once TAPS is diagnosed, it is recommended to refer the patient to a tertiary prenatal diagnosis center with intrauterine treatment conditions for diagnosis and treatment.
±s 表示。超声特征、治疗方式和妊娠结局为计数资料，以例数（%）表示，采用χ2 检验比较供血儿与受血儿超声参数之间的差异。P＜0.05 为差异具有统计学意义。表1 26 例双胎贫血-红细胞增多序列征胎儿产前超声表现 |
| 超声表现 | 分期（例） | 合计[例（%）] | |||
|---|---|---|---|---|---|
| I期（n=11） | II期（n=3） | III期（n=3） | IV期（n=9） | ||
| “黑白”胎盘 | 11 | 3 | 3 | 9 | 26 (100) |
| 受血儿肝呈“星空征” | 11 | 2 | 2 | 9 | 24 (92) |
| 供血儿肠道回声增强 | 0 | 0 | 1 | 3 | 4 (15) |
| 心脏异常 | 9 | 1 | 3 | 9 | 22 (85) |
| 多普勒血流异常 | 9 | 1 | 3 | 5 | 18 (69) |
| 胎儿水肿 | 0 | 0 | 0 | 9 | 9 (34) |
| 羊水量不均衡 | 9 | 0 | 1 | 5 | 15 (57) |
| 脐带异常 | 10 | 2 | 2 | 5 | 19 (73) |
| 合并 sIUGR、TTTS | 6 | 1 | 3 | 5 | 15 (57) |
| 合并其他结构畸形 | 1 | 0 | 0 | 2 | 3 (12) |
注：sIUGR 为选择性宫内生长受限，TTTS 为双胎输血综合征 |
表2 26 例双胎贫血-红细胞增多序列征供血儿与受血儿超声表现对比[例（%）] |
| 项 目 | 供血儿(n=26) | 受血儿(n=26) | x² 值 | P值 |
|---|---|---|---|---|
| 肝呈“星空征” | 0(0) | 24(92) | 44.571 | <0.001 |
| 肠道回声增强 | 4(15) | 0(O) | 4.333 | 0.037 |
| 胎儿水肿 | 9(34) | 1(3) | 7.924 | 0.005 |
| 心胸比增大 | 16(61) | 5(19) | 9.665 | 0.002 |
| 房室瓣反流或频谱单峰 | 11(42) | 7(27) | 1.359 | 0.244 |
| 多普勒血流异常 | 10(26) | 14(54) | 1.238 | 0.266 |
| 脐带水肿 | 0(0) | 6(23) | 6.783 | 0.009 |
| 脐带插入点异常 | 11(42) | 9(34) | 0.325 | 0.569 |
| 羊水量异常 | 8(30) | 11(42) | 0.746 | 0.388 |
图1 双胎贫血-红细胞增多序列征胎儿孕29+1周产前超声图像。图a：供血儿大脑中动脉峰值流速（MCA-PSV）增高，约1.61 中位数倍数（MoM）；图b：受血儿MCA-PSV 降低，约0.87 MoM |
图5 双胎贫血-红细胞增多序列征胎儿孕23+5 周产前超声图像。图a：可见供血儿心胸比增大（约为0.44）；图b：彩色多普勒可见二尖瓣、三尖瓣轻度反流束，连续多普勒测及反流速度约为2.7 m/s |
表3 双胎贫血-红细胞增多序列征胎儿治疗方式及预后 |
| 治疗方式 | 分期 | 例数 | 合并 sIUGR、TTTS | 存活率[%(例/例)] |
|---|---|---|---|---|
| 胎儿镜下胎盘血管吻合支激光凝固术 | I | 3 | 1 | 100 (6/6) |
| II | 0 | 0 | - | |
| III | 0 | 0 | - | |
| IV | 2 | 0 | 100 (4/4) | |
| 射频消融减胎术 | I | 7 | 4 | 86 (6/7) |
| II | 1 | 0 | 100 (1/1) | |
| III | 3 | 3 | 100 (3/3) | |
| IV | 2 | 2 | 100 (2/2) | |
| 期待治疗 | I | 1 | 1 | 0 (0/2) |
| II | 2 | 1 | 100 (4/4) | |
| III | 0 | 0 | - | |
| IV | 4 | 2 | 63 (5/8) |
注：sIUGR 为选择性宫内生长受限，TTTS 为双胎输血综合征，-表示无数据 |
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