双绒毛膜双羊膜囊双胎出生体重不均衡的危险因素:1757例分析  

Risk factors of birth weight discordance in dichorionic diamniotic twin pregnancies:analysis of 1757 cases

作　　者：陈曦 王宏 李笑天 石凡华[2] 王文荣[3] 丁桂春[4] 费晓萍 王霞红[6] 张美华 余淑芳[8] 彭杨 吴红波 成晓燕[11] Chen Xi;Wang Hong;Li Xiaotian;Shi Fanhua;Wang Wenrong;Ding Guichun;Fei Xiaoping;Wang Xiahong;Zhang Meihua;Yu Shufang;Peng Yang;Wu Hongbo;Cheng Xiaoyan(Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Obstetrics,Taian Maternal and Child Health Hospital,Taian 271000,China;Department of Ultrasound,Lianyungang Maternal and Child Healthcare Hospital,Lianyungang 222000,China;Department of Obstetrics,Yangzhou Maternal and Child Health Hospital,Yangzhou 225001,China;Department of Obstetrics,the First People's Hospital of Kunshan,Kunshan 215300,China;Department of Obstetrics,Shanghai Jiading District Maternal and Child Health Hospital,Shanghai 201821,China;Department of Obstetrics,Haiyan Maternal and Child Health Care Hospital,Jiaxing 314300,China;Department of Obstetrics,Cixi Maternal and Child Health Hospital,Cixi 315300,China;Department of Obstetrics,Women and Children Healthcare Hospital of Zhuzhou,Zhuzhou 412000,China;Department of Obstetrics,the Fourth Hospital of Ningbo,Ningbo 315700,China;Department of Obstetrics,Nantong Maternal and Child Health Care Hospital,Nantong 226000,China)

机构地区：[1]复旦大学附属妇产科医院产科,上海200011 [2]山东省泰安市妇幼保健院产科,271000 [3]连云港市妇幼保健院超声科,222000 [4]扬州市妇幼保健院产科,225001 [5]昆山市第一人民医院产科,215300 [6]上海市嘉定区妇幼保健院产科,201821 [7]嘉兴市海盐县妇幼保健院产科,314300 [8]慈溪市妇幼保健院产科,315300 [9]株洲市妇幼保健院产科,412000 [10]宁波市第四医院产科,315700 [11]南通市妇幼保健院产科,226000 [12]复旦大学附属妇产科医院妇产科,上海200011

出　　处：《中华围产医学杂志》2020年第10期695-701,共7页Chinese Journal of Perinatal Medicine

基　　金：上海市科学技术委员会基金(17411950501)。

摘　　要：目的:分析双绒毛膜双羊膜囊(dichorionic diamniotic,DCDA)双胎出生体重不均衡的危险因素。方法:回顾性分析2014年1月1日至2017年12月31日我国11家医院分娩的1757例DCDA病例。以双胎新生儿出生体重差≥20%为出生体重不均衡诊断标准,据此将1757例分为出生体重均衡组(1520例)和出生体重不均衡组(237例)。分析孕妇的一般情况及出生体重不均衡的危险因素。采用Mann-Whitney U检验、χ^2检验或Fisher精确概率法,以及logistic回归分析进行统计分析。结果:出生体重不均衡组与出生体重均衡组相比,妊娠期高血压疾病[24.5%(58/237)与12.8%(194/1520)]、胎儿结构异常[4.2%(10/237)与1.0%(15/1520)]、胎儿窘迫[6.3%(15/237)与1.4%(21/1520)]、脐带异常[3.8%(9/237)与1.2%(18/1520)]、脐带附着异常[3.8%(9/237)与1.4%(21/1520)]等发生率较高(χ^2值分别为22.882、15.160、22.602、7.607及34.904,P值均<0.05),但胎膜早破的发生率较低[11.0%(26/237)与16.5%(250/1520),χ^2=4.645,P=0.034]。将单因素分析中差异有统计学意义的变量纳入多因素logistic回归分析发现,DCDA双胎出生体重不均衡的危险因素是妊娠期高血压疾病(OR=2.258,95%CI:1.620~3.148,P<0.001)、胎儿结构异常(OR=4.268,95%CI:1.892~9.631,P<0.001)、脐带异常(OR=2.889,95%CI:1.245~6.705,P=0.014)、脐带附着异常(OR=2.318,95%CI:1.012~5.311,P=0.047)。结论:DCDA双胎发生出生体重不均衡与妊娠期高血压疾病、胎儿结构异常、脐带异常、脐带附着异常等危险因素有关。Objective To investigate the risk factors of birth weight discordance in dichorionic diamniotic(DCDA)twins.Methods This study retrospectively analyzed 1757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1,2014,to December 31,2017.Birth weight discordance was defined as≥20%difference between the twins.All cases were divided into two groups:the concordant group(n=1520)and discordant group(n=237).General information was compared and the high-risk factors of birth weight discordance were analyzed.Mann-Whitney U test,Chi-square test or Fisher's exact test,and logistic regression analysis were used as statistical methods.Results Compared with the concordant group,the discordant group showed a higher incidence of hypertensive disorders of pregnancy[24.5%(58/237)vs 12.8%(194/1520),χ^2=22.882,P<0.05],fetal structural malformations[4.2%(10/237)vs 1.0%(15/1520),χ^2=15.160,P<0.05],fetal distress[6.3%(15/237)vs 1.4%(21/1520),χ^2=22.602,P<0.05],umbilical cord abnormalities[3.8%(9/237)vs 1.2%(18/1520),χ^2=7.607,P<0.05]and abnormal placental cord insertion[3.8%(9/237)vs 1.4%(21/1520),χ^2=34.904,P<0.05],but lower incidence of premature rupture of membranes[11.0%(26/237)vs 16.5%(250/1520),χ^2=4.645,P=0.034].Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy(OR=2.258,95%CI:1.620-3.184,P<0.001),fetal structural malformations(OR=4.268,95%CI:1.892-9.631,P<0.001),umbilical cord abnormalities(OR=2.889,95%CI:1.245-6.705,P=0.014)and abnormal placental cord insertion(OR=2.318,95%CI:1.012-5.311,P=0.047).Conclusions Hypertensive disorders of pregnancy,fetal structural malformations,umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.

关 键 词：双生 二卵 出生体重 危险因素 妊娠并发症 

分 类 号：R714.23[医药卫生—妇产科学]