双胎妊娠早期早产危险因素的相关性分析  

Correlation analysis of risk factors for early preterm birth in twin pregnancy

作　　者：张梦莹[1] 玛丽帕提·马尔旦 刘璇璇 张潇潇[1] 时春艳[1] 孙笑[1] ZHANG Mengying;Maerdan Malipati;LIU Xuanxuan;ZHANG Xiaoxiao;SHI Chunyan;SUN Xiao(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,Xilingol League Central Hospital,Xilinhot,Inner Mongolia Autonomous Region 026000,China)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]锡林郭勒盟中心医院妇产科,内蒙古自治区锡林浩特市026000

出　　处：《中国妇产科临床杂志》2024年第4期327-330,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：北京大学第一医院科研种子基金(2024SF30)。

摘　　要：目的探讨双胎妊娠发生早期早产(<34周)的危险因素及不同危险因素对早期早产影响的相关性。方法本研究为回顾性研究,选取2018年1月至2022年12月在北京大学第一医院早产分娩且病例资料完整的双胎孕妇233例。采用二元logistic回归分析早期早产的独立危险因素以及不同危险因素与早期早产的相关性。结果(1)妊娠20~23^(+6)周及妊娠24~28周超声宫颈平均长度比较,差异有统计学意义(P<0.05),且宫颈缩短(<25 mm)在妊娠34周前分娩组发生率更高,早期早产组宫颈环扎术率更高,差异有统计学意义(P<0.05)。(2)妊娠20~23^(+6)周宫颈缩短是妊娠34周前双胎早产的独立危险因素(OR=4.251,95%CI:1.942~9.305,P<0.05)。(3)妊娠20~23^(+6)周宫颈≤15 mm及15 mm37.8 mm的12.67倍(95%CI:3.301~48.606)及3.694倍(95%CI:1.314~10.389)。(4)以宫颈长度15 mm、20 mm、25 mm分别作为界值预测妊娠34周前双胎早产,随着界值的增加,预测妊娠34周前早产的灵敏度分别为18.6%、21.6%、33%,但特异度、阳性预测值逐渐下降,阴性预测值变化不大。结论妊娠20~23^(+6)周宫颈缩短是双胎早期早产的独立危险因素,妊娠20~23^(+6)周宫颈≤15 mm较宫颈>15 mm发生早期早产的风险高。Objective To investigate the risk factors of early preterm birth(<34 weeks)in twin pregnancy and the correlation of between different risk factors on early preterm birth.Methods In this retrospective study,233 preterm twins with complete case data and preterm delivery were selected from Peking University First Hospital from January 2018 to December 2022.Binary logistic regression analysis was used to analyze the independent risk factors of early preterm birth and the correlation between different risk factors and early preterm birth.Results①There were statistically significant differences in average cervical length(CL)between 20 to 23+6 weeks of gestation and 24 to 28 weeks of gestation(P<0.05),and the incidence of cervical shortening(<25 mm)was higher in the delivery group before 34 weeks,and the cervical ceration rate was higher in the early preterm delivery group.The difference was statistically significant(P<0.05).②Binary Logistic multivariate regression analysis indicated that shortened cervical length at 20 to 23+6 weeks of gestation was an independent risk factor for preterm birth of twins before 34 weeks(OR=4.251,95%CI:1.942-9.305,P<0.05).③The risk of preterm birth before 34 weeks was 12.67 times(95%CI,3.301~48.606)and 7.74 times(95%CI,1.920-31.213)higher than that of cervical length>37.8 mm and 15<CL≤25 mm at 20 to 23+6 weeks gestation.④The cervical length of 15 mm,20 mm and 25 mm was used as the threshold to predict premature birth of twins before 34 weeks.With the increase of the threshold,the sensitivity to predict premature birth before 34 weeks was 18.6%、21.6%、33%,respectively,but the specificity and positive predictive value gradually decreased,and the negative predictive value did not change much.Conclusions Cervical shortening at 20~23+6 weeks of gestation is an independent risk factor for early preterm birth in twins.Cervical length≤15 mm at 20~23+6 weeks gestation is a higher risk of early preterm birth than cervical length>15 mm.

关 键 词：双胎妊娠 宫颈长度 早期早产 危险因素 预测价值 

分 类 号：R714.21[医药卫生—妇产科学]