目的:回顾镜像综合征的诊断标准并描述其临床表现。
方法:来自PubMed的数据库,Scopus,科克伦图书馆,ClinicalTrials.gov,从开始到2022年2月,我们向CINAHL查询了包含≥2例镜像综合征的病例系列。
方法:如果研究报告的镜子综合征≥2例,则包括病例报告,案例系列,队列研究,和病例对照研究。
方法:独立评估研究质量和偏倚风险。使用MicrosoftExcel对数据进行制表,并使用叙述性审查和描述性统计进行汇总。本系统评价是根据系统评价和荟萃分析(PRISMA)声明的首选报告项目进行的。对所有符合条件的参考文献进行评估。独立进行记录筛选和数据提取,第三作者解决了分歧。
结果:在13次引用中,12项研究(n=82)报告了镜像综合征的诊断标准:母体水肿(11/12),胎儿水肿(9/12),胎盘水肿(6/12),胎盘肿大(5/12),和先兆子痫(2/12)。12项研究(n=82)描述了镜像综合征的临床表现为母体水肿(62.2%),低蛋白血症(54.9%),贫血(39.0%),和新发高血压(39.0%)。四项研究(n=36)报告所有患者均存在血液稀释。8项研究(n=36)报道了胎儿水肿的病因,最常见的是结构性心脏畸形(19.4%),α地中海贫血(19.4%),Rh等免疫(13.9%),和非免疫性胎儿水肿(13.9%)。六项研究(n=47)报告了产妇并发症,其中89.4%是严重的:产后出血(44.7%),需要输血的出血(19.1%),ICU住院(12.8%),心力衰竭(10.6%),肺水肿(8.5%),肾功能不全(8.5%)。在39个案例中,报告的胎儿结局为死产(66.6%)和新生儿或婴儿死亡(25.6%).继续妊娠的总生存率为7.7%。
结论:镜像综合征的诊断标准在研究中存在很大差异。镜像综合征临床表现与先兆子痫重叠。只有四项研究讨论了血液稀释。显著的产妇发病率和胎儿死亡率与镜像综合征相关。需要进一步的研究来阐明镜像综合征的发病机理,以更好地指导临床医生识别和管理病情。
This study aimed to
review the diagnostic criteria for mirror syndrome and describe its clinical presentation.
Databases from PubMed, Scopus, Cochrane Library, ClinicalTrials.gov, and CINAHL were inquired for case series containing ≥2 cases of mirror syndrome from inception to February 2022.
Studies were included if they reported ≥2 cases of mirror syndrome and included case reports, case series, cohort studies, and case-control studies.
The studies\' quality and risk of bias were independently assessed. Data were tabulated using Microsoft Excel and summarized using narrative
review and descriptive statistics. This systematic
review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. All eligible references were assessed. Screening of records and data extraction were independently performed, and a third author resolved disagreements.
Of 13 citations, 12 studies (n=82) reported diagnostic criteria for mirror syndrome: maternal edema (11/12), fetal hydrops (9/12), placental edema (6/12), placentomegaly (5/12), and preeclampsia (2/12); 12 studies (n=82) described the clinical presentation of mirror syndrome as maternal edema (62.2%), hypoalbuminemia (54.9%), anemia (39.0%), and new-onset hypertension (39.0%); 4 studies (n=36) reported that hemodilution was present in all patients; 8 studies (n=36) reported the etiology of fetal hydrops, with the most common being structural cardiac malformations (19.4%), alpha thalassemia (19.4%), Rh isoimmunization (13.9%), and nonimmune hydrops fetalis (13.9%); and 6 studies (n=47) reported maternal complications, 89.4% of which were major: postpartum hemorrhage (44.7%), hemorrhage requiring blood transfusion (19.1%), intensive care unit admission (12.8%), heart failure (10.6%), pulmonary edema (8.5%), and renal dysfunction (8.5%). In 39 cases, the reported fetal outcomes were stillbirth (66.6%) and neonatal or infant death (25.6%). The overall survival rate among continued pregnancies was 7.7%.
The diagnostic criteria of mirror syndrome differed considerably among studies. Mirror syndrome clinical presentation overlapped with preeclampsia. Only 4 studies discussed hemodilution. Significant maternal morbidity and fetal mortality were associated with mirror syndrome. Further research is warranted to elucidate the pathogenesis of mirror syndrome to better guide clinicians in identifying and managing the condition.