胎龄≤34周双胎输血综合征早产儿预后及其影响因素  

Prognosis and its influencing factors for premature infants complicated by twin-twin transfusion syndrome and born at≤34 weeks'gestation

作　　者：张腾月 武海艳 莫新悦 王鸿鑫 潘文序 李易娟[1] 黄越芳[1] Zhang Tengyue;Wu Haiyan;Mo Xinyue;Wang Hongxin;Pan Wenxu;Li Yijuan;Huang Yuefang(Department of Pediatrics,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Pediatrics,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]中山大学附属第一医院儿科,广州510080 [2]广州医科大学附属妇女儿童医疗中心儿科,广州510623

出　　处：《中华围产医学杂志》2024年第2期96-105,共10页Chinese Journal of Perinatal Medicine

基　　金：广东省基础与应用基础研究基金自然科学基金(2021A1515012072)。

摘　　要：目的探讨胎龄≤34周双胎输血综合征(twin-twin transfusion syndrome,TTTS)早产儿预后及其影响因素。方法2003年1月至2019年2月在中山大学附属第一医院分娩的妊娠≤34周的TTTS孕妇共68例,其中生后转入新生儿重症监护病房的TTTS早产儿共106例(TTTS组)纳入回顾性分析。在同期入住新生儿重症监护病房的非TTTS双胎早产儿中选择与TTTS组早产儿孕母年龄相差2岁以内,出生胎龄相差1周以内,且无先天性畸形、未接受过宫内干预并资料完整者178例作为对照(非TTTS组)。总结胎龄≤34周TTTS早产儿预后,比较不同宫内干预方式、受血儿与供血儿、轻度与重度TTTS早产儿以及TTTS与非TTTS双胎早产儿生后早期并发症及早产儿结局(生后存活≥28 d定义为存活,存活<28 d定义为死亡)的差异,分析影响胎龄≤34周TTTS早产儿存活的危险因素。采用两独立样本t检验、单因素方差分析、秩和检验、χ^(2)检验和有序logistic回归进行统计分析。结果(1)妊娠≤34周TTTS孕妇68例,双胎存活率为48.5%(33/68),至少一胎存活率为95.6%(65/68),早产儿存活率为72.1%(98/136)。(2)106例TTTS早产儿中受血儿62例,供血儿44例;Ⅰ~Ⅱ期(轻度)TTTS早产儿41例,Ⅲ~Ⅴ期(重度)65例。(3)重度TTTS早产儿严重脑损伤发生率高于轻度TTTS组[9.2%(6/65)与0.0%(0/41),χ^(2)=4.01,P=0.045];(4)出生胎龄≤28周(OR=101.90,95%CI:5.07~2048.37)和TTTSⅣ期(OR=14.04,95%CI:1.56~126.32)、Ⅴ期(OR=51.09,95%CI:3.58~728.81)是TTTS早产儿死亡的危险因素(P值均<0.05)。(5)TTTS组早产儿新生儿期贫血[51.9%(55/106)与33.1%(59/178),χ^(2)=9.71]、红细胞增多症[5.7%(6/106)与0.6%(1/178),χ^(2)=7.18]、新生儿持续性肺动脉高压[3.8%(4/106)与0.0%(0/178),χ^(2)=6.81]、新生儿败血症[15.1%(16/106)与7.3%(13/178),χ^(2)=4.40]、早产儿视网膜病变≥Ⅲ期[3.8%(4/106)与0.0%(0/178),χ^(2)=6.81]、先天性心脏结构异常[19.8%(21/106)与0.6%(1/178),χ^(2)=33.45]、心力衰竭[8.5%ObjectiveTo investigate the perinatal prognosis and its impact factors for premature infants with twin-twin transfusion syndrome(TTTS)who were born at≤34 weeks of gestation.MethodsA retrospective study was conducted on 68 pregnancies of TTTS with gestational age≤34 weeks at delivery,among them 106 preterm infants(TTTS group)were admitted to the neonatal intensive care unit of the First Affiliated Hospital,Sun Yat-sen University from January 2003 to February 2019.During the same period,another 178 twins without TTTS,congenital malformation,and intrauterine intervention who matched the TTTS group in maternal age(differences within two years)and gestational age(differences within one week)were assigned as non-TTTS group.Perinatal prognosis of TTTS infants born at≤34 weeks was analyzed by comparing the differences in postnatal early complications and perinatal outcomes(survival time morn than 28 days or not)between the TTTS and non-TTTS groups,recipient and donor twins,mild and severe TTTS infants,and among TTTS infants with different intrauterine interventions.The risk factors for perinatal survival in TTTS infants with gestational age≤34 weeks were analyzed.Two independent samples t-test,one-way analysis of variance,rank-sum test,Chi-square test,and ordered logistic regression were used for statistical analysis.Results(1)Among the 68 pregnancies,the overall perinatal survival rate of the neonates was 72.1%(98/136),the double-twin survival rate was 48.5%(33/68),and the rate of at least one survivor was 95.6%(65/68).(2)In the TTTS group,62 were recipients and 44 were donors.StageⅠ-ⅡTTTS was found in 41 cases(mild TTTS group)and stageⅢ-Ⅴin 65 cases(severe TTTS group).(3)The rate of severe brain injury was higher in the severe-TTTS group than those in the mild-TTTS group[9.2%(6/65)vs.0.0%(0/41),χ^(2)=4.01,P=0.045].(4)Gestational age≤28 weeks(OR=101.90,95%CI:5.07-2048.37),stageⅣ(OR=14.04,95%CI:1.56-126.32)and stageⅤTTTS(OR=51.09,95%CI:3.58-728.81)were independent risk factors for death within 28 d

关 键 词：双胎输血综合征 婴儿 早产 存活率 预后 影响因素分析 

分 类 号：R722.6[医药卫生—儿科]