双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析  

Analysis of The Tendency,Characteristic and Risk Factors of Twin Pregnancy Complicated with Preeclampsia

作　　者：陈维[1] 王子莲[1] CHEN Wei;WANG Zi-lian(Department of Obstetrics&Gynecology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2021年第1期145-153,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：中山大学临床医学研究5010计划项目(2012004)。

摘　　要：【目的】探讨双胎妊娠并发子痫前期的发病趋势、特征及危险因素。【方法】回顾性分析2011年1月至2019年12月在中山大学附属第一医院住院分娩的1542例双胎妊娠孕妇子痫前期的发病趋势。最终1384例双胎妊娠孕妇纳入后续发病特征及危险因素分析,根据绒毛膜性将其分为单绒毛膜性(monochorionic,MC)组和双绒毛模性(dichorionic,DC)组,MC共有403例,其中子痫前期(preeclampsia,PE)组55例,非PE组348例;DC共有981例,其中PE组105例,非PE组876例;分别比较不同绒毛膜性孕妇PE组和非PE组的基本资料和分娩结局,采用单因素分析和多因素Logistic回归分析不同绒毛膜性双胎妊娠发生子痫前期的危险因素。【结果】双胎妊娠PE的总发病率为10.4%,2011-2019年各年PE的发病率在7.8%~11.8%之间波动。无论MC与DC双胎妊娠,PE组孕妇贫血(MC为58.2%和39.7%,P=0.010;DC为59%和38%,P=0.000)、低蛋白血症(MC为7.3%和1.7%,P=0.035;DC为10.5%和0.7%,P=0.000)、早产(MC为94.5%和70.1%,P=0.000;DC为89.5%和54.8%,P=0.000)、产后出血(MC为21.8%和10.6%,P=0.018;DC为20.9%和13.4%,P=0.035)、新生儿转新生儿重症监护室(MC为49.1%和28.6%,P=0.000;DC为26.7%和15.6%,P=0.000)的发生率均较非PE组高,组间差异有统计学意义;DC双胎妊娠PE组小胎出生体质量和大胎出生体质量均较非PE组轻,组间差异有统计学意义(P=0.000;P=0.017)。孕期增重过多、辅助生殖技术受孕是MC双胎PE的独立危险因素;孕前BMI≥24 kg/m^2、孕期增重过多、双胎体质量差过大是DC双胎妊娠PE的独立危险因素。【结论】双胎妊娠PE的发病率波动于7.8%~11.8%;不同绒毛膜性双胎妊娠PE的危险因素和分娩结局略有差异;孕期增重过多、辅助生殖技术受孕、孕前BMI≥24 kg/m2、双胎体质量差过大是双胎妊娠PE的危险因素,提示孕期体质量管理尤为重要。【Objective】To investigate the tendency,characteristic and risk factors of twin pregnancy complicated with preeclampsia.【Methods】A retrospective analysis was performed on the incidence trend of preeclampsia in 1542 twin pregnant women who were hospitalized for delivery in the First Affiliated Hospital of Sun Yat-sen University from January 2011 to December 2019.Finally,1384 twin pregnant women were included in the analysis of subsequent morbidity characteristics and risk factors,who were divided into Monochorionic(MC)group and Dichorionic(DC)group according to chorionicity.There were 403 MC cases,including 55 cases in Preeclampsia(PE)group and 348 cases in non-PE group and 981 DC cases,including 105 cases in PE group and 876 cases in non-PE group.The basic characteristics and delivery outcomes of different chorionic pregnant women in PE group and non-PE group were compared respectively.Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of preeclampsia in different chorionic twin pregnancies.【Results】The total incidence of PE in twin pregnancies was 10.4%,the incidence of PE in twin pregnancies from 2011 to 2019 varied between 7.8%and 11.8%.Regardless of MC and DC twin pregnancies,the incidence of anemia(MC:58.2%vs 39.7%,P=0.010;DC:59%vs 38%,P=0.000),hypoproteinemia(MC:7.3%vs 1.7%,P=0.035;DC:10.5%vs 0.7%,P=0.000),premature delivery(MC:94.5%vs 70.1%,P=0.000;DC:89.5%vs 54.8%,P=0.000),postpartum hemorrhage(MC:21.8%vs 10.6%,P=0.018;DC:20.9%vs 13.4%,P=0.035),neonatal transfer to intensive care unit(MC:49.1%vs 28.6%,P=0.000;DC:26.7%vs 15.6%,P=0.000)in pregnant women in PE group was higher than that in non-PE group,the difference between the two groups were statistically significant.the birth weight of both small fetuses and large fetuses in PE group of DC twins was lower than that in the non-PE group,the difference between these two groups were also statistically significant(P=0.000;P=0.017).Excessive weight gain during pregnancy and assisted reproductive t

关 键 词：双胎妊娠 子痫前期 危险因素 分娩结局 

分 类 号：R714.23[医药卫生—妇产科学]