镜像综合征20例临床特征探讨

目的探讨镜像综合征病因、临床特征和妊娠结局。方法回顾性分析广州医学院第三附属医院2005年1月至2012年9月20例镜像综合征病例的临床表现。结果水肿胎儿发病率0．219％，镜像综合征发病率0．0472％。平均发病孕周27．95±3．72周，Bart’s水肿胎为镜像综合征的主要病因共12例，占60％，不明原因8例，占40％。超声和病理提示胎儿和胎盘水肿。母体100％发生水肿和蛋白尿，70％（14／20）发生高血压，20％（4／20）发生肺水肿。血液检查显示血液稀释HCT均值为27．58±2．72％，低血色素89．94±10．41g/L，低蛋白血症（白蛋白21．72±4．53g／L），尿酸水平增高612．53±124．20umol／L，15％孕妇肝酶轻度增高。临床处理为对症及终止妊娠。分娩平均孕周31．28±2．65周，20例围产儿均死亡。阴道分娩12例，剖宫产8例。发生产后出血共7例，占35％（7／20）。母体症状在产后1—7天改善。结论镜像综合征病因主要为Bart’s水肿胎，表现为母体、胎儿、胎盘水肿三联征，围生儿预后不良，母体易发生高血压、肺水肿和产后出血，终止妊娠后，母体的情况得到迅速改善。

Investigate the clinical characteristics of 20 cases with mirror syndrome

Objective ： To investigate the clinical characteristics of mirror syndrome. Methods ： Retrospective analysis of 20 cases with mirror syndrome in January 2005 to September 2012 in the third affiliated hospital of Guangzhou medical college. Data of clinical manifestations, laboratory examinations, placental morphology, treatment and prognosis of these patients were obtained and studied. Results： Fetal hydrops incidence was 0. 219%, mirror syndrome incidence was 0. 0472%. Mirror syndrome was associated with Bart＇ s syndromel2 cases （60%）, unknown cause 8 cases （40%）. ultrasound detected fetal hydrops and placentomegaly, placental mor- phology showed villous edema. Maternal edema happen in 27.95 ± 3.72 weeks （ 16 ^＋5 weeks to 34 ^＋1 week）, The key specific symp-toms were maternal edema and proteinuria （ 100% ）, hemodilution （ 100% ）, hypertension （70%）, pulmonary edema （20%）. labo- ratory examinations showed average hematocrit 27.58 ± 2. 72%, Hemoglobin 89.94 ± 10. 41g/L, albuminemia 21.72 ± 4. 53g/L, uric acid 612. 53 ± 124. 20umol/L and 15% mild elevated alanine aminotransferase. Termination of pregnancy average gestational weeks were 31.28 ±2. 65 weeks （26 ^＋ 2 weeks - 36 ^＋ 3 weeks）. Perinatal mortality rate was 100% （20/20）, 12 patients delivered vagina- lty and 8 underwent cesarean section. 35% （7/20） occurred postpartum hemorrhage. Patients recovered rapidly after termination of pregnancyl -7day. Conclusion： Main cause of Mirror syndrome were Bart＇s syndrome, It characterizes maternal edema related to se-vere fetal hydrops and placental edema, fetus lead to a poor prognosis, Maternal complicated by preeclampsia - like symptoms, after delivery fetal, maternal symptoms can spontaneous resolved.