单绒毛膜双羊膜囊双胎选择性胎儿生长受限：ISUOG与Delphi诊断标准的围产结局比较
该回顾性队列研究纳入2000年至2024年间363例单绒毛膜双羊膜囊双胎妊娠，比较Delphi共识定义与ISUOG传统定义对选择性胎儿生长受限（sFGR）的诊断性能及围产结局预测价值。Delphi标准诊断率更高（30.3% vs 14.6%），但仅由Delphi标准诊断的额外病例双胎完整存活率显著高于ISUOG标准诊断者（63.2% vs 26.4%），且新生儿发病率更低。Delphi标准各组成标准均独立与双胎完整存活率降低相关，但预测胎儿死亡 discriminative 能力低至中等。
要点
- Delphi标准诊断sFGR率高于ISUOG标准（30.3% vs 14.6%），但额外诊断病例围产结局更好。
- 仅由Delphi标准诊断的57例双胎完整存活率显著高于ISUOG标准诊断的53例（63.2% vs 26.4%）。
- Delphi标准各组成标准均独立与双胎完整存活率降低相关，但预测胎儿死亡能力有限（AUC均>0.6）。
核心结论
- Delphi标准较ISUOG标准诊断sFGR的检出率更高，但仅由Delphi标准额外诊断的病例围产病率和死亡率显著低于符合ISUOG定义的病例。
- Delphi定义中每个组成标准均独立与sFGR双胎妊娠的不良结局相关，但各标准组合预测胎儿死亡的 discriminative 能力低至中等（AUC均>0.6）。
- 需要进一步研究以明确诊断和分类MCDA双胎妊娠合并sFGR的最合适工具。
研究设计与样本
- 回顾性队列研究，纳入2000年1月至2024年1月期间在一家三级胎儿医学中心随访的单绒毛膜双羊膜囊（MCDA）双胎妊娠。
- 排除在sFGR诊断时或之前诊断为双胎输血综合征或双胎贫血-红细胞增多序列征的病例，以及胎儿结构或遗传学异常的病例。
- 最终分析纳入363例MCDA双胎妊娠，使用绒毛膜性特异性双胎参考图表评估胎儿生长，分别采用ISUOG或Delphi定义诊断sFGR。
主要发现
- 363例MCDA双胎妊娠中，Delphi共识定义诊断sFGR 110例（30.3%），ISUOG标准仅诊断53例（14.6%）。
- ISUOG标准诊断的53例中双胎完整存活率为26.4%，显著低于仅由Delphi标准诊断的57例的63.2%，后者新生儿发病率也显著更低。
- Logistic回归分析显示Delphi定义的每个组成标准均独立与双胎完整存活率显著降低相关。
- 所有Delphi标准组合预测较小和/或较大胎儿死亡的 discriminative 能力低至中等（所有ROC曲线下面积>0.6）。
- 预测较小胎儿死亡时，Delphi标准敏感性略高于ISUOG标准（0.840 vs 0.789），但特异性较低（0.743 vs 0.877）；预测较大胎儿死亡和双胎死亡时结果相似。
关键数值与推荐
- Delphi共识定义诊断sFGR率30.3%（110/363），ISUOG标准诊断率14.6%（53/363）。
- ISUOG标准诊断病例双胎完整存活率26.4%（14/53），仅Delphi标准诊断病例63.2%（36/57）。
- 预测较小胎儿死亡：Delphi标准敏感性0.840、特异性0.743；ISUOG标准敏感性0.789、特异性0.877。
- Delphi各标准组合预测胎儿死亡的ROC曲线下面积均>0.6。
临床怎么用
- 临床采用Delphi共识定义可提高sFGR检出率，但需注意仅由Delphi标准诊断的病例围产结局相对较好。
- Delphi标准各组成标准均与不良结局独立相关，评估时应综合考量各标准而非仅依赖单一指标。
- 现有标准预测胎儿死亡的 discriminative 能力有限，临床决策需结合其他监测指标。
局限性
- 回顾性队列研究设计，可能存在选择偏倚和信息偏倚。
- 单中心三级胎儿医学中心数据，外推性需谨慎。
- 仅由Delphi标准诊断的病例样本量较小（57例），统计效能有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy. METHODS: This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. RESULTS: The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve > 0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise. CONCLUSIONS: While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
引用
- Sorrenti S, Yaghi O, Prasad S, et al. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction: ISUOG vs Delphi diagnostic criteria. Ultrasound Obstet Gynecol. 2026. PMID: 42126513. doi:10.1002/uog.70239
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。