| Project/Area Number |
17K16875
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| Research Category |
Grant-in-Aid for Young Scientists (B)
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| Allocation Type | Multi-year Fund |
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| Research Field |
Obstetrics and gynecology
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| Research Institution | Yamaguchi University (2018-2020)
Kawasaki Medical School (2017) |
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Principal Investigator |
Murata Susumu 山口大学, 医学部附属病院, 助教 (00420521)
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| Project Period (FY) |
2017-04-01 – 2021-03-31
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| Project Status |
Completed (Fiscal Year 2020)
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| Budget Amount *help |
¥3,640,000 (Direct Cost: ¥2,800,000、Indirect Cost: ¥840,000)
Fiscal Year 2019: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2018: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
Fiscal Year 2017: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
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| Keywords | 双胎間輸血症候群 / 受血児心不全 / 右室流出路狭窄 / 心不全マーカー / ナトリウム利尿ペプチド前駆体 / 胎児治療 / 心不全 / 羊水 / 超音波 / 周産期医学 / 双胎 / 一絨毛膜二羊膜性双胎 / 心機能 |
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| Outline of Final Research Achievements |
This study was to evaluate the recipient cardiac function who underwent fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). The cardiac function was measured by ultrasound myocardial performance index (MPI) and amniotic fluid levels of brain-type natriuretic peptide (NT-pro BNP) in the recipients. During this study, 25 women underwent FLP. Of the 21 cases were Quintero stage 1 to stage 3 donor (group A), and 4 cases were stage3 recipient to stage4 (group B). There was no significant difference in the median left ventricular MPI of the recipients between the group A and B (0.49 vs. 0.40, p>0.05) and the median right ventricular MPI (0.49 vs. 0.44, p>0.05). However, the median NT-pro BNP / TP ratio (TP: protein concentration, ng/g) was 1385 (153-3105) in group A and 3773 (1846-6450) in group B, NT-pro BNP in group B was significantly higher than group A (p<0.05). The NT-pro BNP / TP ratio is a useful index for evaluation of the recipient cardiac function.
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| Academic Significance and Societal Importance of the Research Achievements |
双胎妊娠で一絨毛膜性双胎に発症する双胎間輸血症候群は、循環血液量が減少する供血児と、循環血液量が増加する受血児が発生する。受血児は血液量増加により心不全を来し易い。現在では胎児鏡下胎盤吻合血管レーザー凝固術が普及し、双胎間輸血症候群は胎児期に治療可能となり、生存率も向上した。しかし、レーザー凝固術後でも受血児心不全が治癒しないことがある。本研究では、受血児の心不全を超音波検査以外の手法で検出する検討を行った。結果、レーザー凝固中に採取する受血児の羊水の検討で術前に心不全が疑われる受血児は、心不全が疑われない受血児に比べ、統計学的に有意に心不全マーカーの数値が高値となることが判明した。
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