摘要
目的探讨不同胎龄双胎出生体质量不一致(birth weight discordant twins,BWDT)早产儿的围产相关因素及并发症情况。方法回顾性分析2013年1月至2022年12月在武汉科技大学附属孝感医院出生并存活的BWDT早产儿及其孕母的临床资料,按照不同胎龄分为<32周组、32~33+6周组及34~36^(+6)周组,分析不同胎龄段BWDT发生的相关因素及并发症。统计学方法采用LSD-t检验、单因素方差分析、χ^(2)检验、Fisher确切概率法、Logistic回归分析、Bonferroni法。结果128对BWDT早产儿平均胎龄为(34.5±2.2)周,BWDT早产儿发生率为13.1%(128/977),其中<32周组占11.7%(15/128),32~33+6周组占32.0%(41/128),34~36^(+6)周组占56.3%(72/128)。34~36^(+6)周组孕母患妊娠期高血压比例显著高于<32周组及32~33+6周组[48.8%(35/72)与20.0%(3/15)、26.8%(11/41)],差异有统计学意义(P<0.017)。<32周组胎盘异常发生率明显高于32~33+6周组及34~36^(+6)周组[73.3%(11/15)与39.0%(16/41)、34.7%(25/72)];<32周组脐带异常发生率显著高于32~33+6周组及34~36^(+6)周组[40.0%(6/15)与14.6%(6/41)、12.5%(9/72)];差异均有统计学意义(P值均<0.017)。校正疾病发生的相关影响因素后,Logistic回归分析结果显示,孕母合并妊娠期高血压(OR=1.452,95%CI:1.268~6.703,P=0.041)时,BWDT发生风险显著升高;胎盘异常及脐带异常发生风险无明显升高(P值均>0.05)。在BWDT早产儿中,<32周组出生体质量小者喂养不耐受发生率明显高于32~33+6周组及34~36^(+6)周组[73.3%(11/15)与26.8%(11/41)、12.5%(9/72)];<32周组出生体质量小者脑损伤发生率明显高于34~36^(+6)周组[40.0%(6/15)与11.1%(8/72)];34~36^(+6)周组出生体质量小者小于胎龄儿发生率明显高于<32周组及32~33+6周组[54.2%(39/72)与20.0%(3/15)、19.5%(8/41)];差异均有统计学意义(P值均<0.017)。结论BWDT在晚期早产儿中发病风险较高;胎盘和脐带因素对早期早产儿BWDT的发生起重要作用,妊娠期高血压对晚期早产儿BWDT的发生影响更甚,且能作为独立危险因素影响BWDT的发生;早期早产儿中BWDT出生体质量小者易发生喂养不耐受和脑损伤,晚期早产儿中其发生小于胎龄儿的风险更高。
Objective To explore the perinatal related factors and complications of premature infants with birth weight discordant twins(BWDT)at different gestational ages.Method The clinical data of born and surviving premature infants with BWDT and their mothers at Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2013 to December 2022 were retrospectively analyzed,and they were divided into<32 weeks group,32-33+6 weeks group,and 34-36^(+6) weeks group according to different gestational ages,and analyze the relevant factors and complications of BWDT occurrence in different gestational age groups.The statistical methods performed by LSD-t test,one-way ANOVA,χ^(2) test,Fisher exact probability method,Logistic regression analysis and Bonferroni method.Result The average gestational age of 128 pairs of premature infants with BWDT was(34.5±2.2)weeks,and the incidence of premature infants with BWDT was 13.1%(128/977),with 11.7%(15/128)in the<32 weeks group,32.0%(41/128)in the 32-33+6 weeks group,and 56.3%(72/128)in the 34-36^(+6) weeks group.The proportion of pregnant women with gestational hypertension in the 34-36^(+6) weeks group was significantly higher than that in the<32 weeks group and the 32-33+6 weeks group[48.8%(35/72)vs 20.0%(3/15),26.8%(11/41)],and the difference was statistically significant(P<0.017).The incidence of placental abnormalities in the<32 weeks group was significantly higher than that in the 32-33+6 weeks group and the 34-36^(+6) weeks group[73.3%(11/15)vs 39.0%(16/41)and 34.7%(25/72)],the incidence of umbilical cord abnormalities in the<32 weeks group was significantly higher than that in the 32-33+6 weeks group and the 34-36^(+6) weeks group[40.0%(6/15)vs 14.6%(6/41),12.5%(9/72)],and the differences were statistically significant(all P<0.017).After adjusting for factors related to disease occurrence,Logistic regression analysis showed that the risk of BWDT was significantly increased in women with gestational hypertension(OR=1.452,95%CI:1.268-6.703,P=0.041).There was no significant increase in the risk of placental and umbilical cord abnormalities(all P>0.05).In premature infants with BWDT,the incidence of feeding intolerance in the<32 weeks group with small birth weight was significantly higher than that in the 32-33+6 weeks group and the 34-36^(+6) weeks group[73.3%(11/15)vs 26.8%(11/41),12.5%(9/72)].The incidence of brain injury in the<32 weeks group with small birth weight was significantly higher than that in the 34-36^(+6) weeks group[40.0%(6/15)vs 11.1%(8/72)],the incidence of small for gestational age infant in the 34-36^(+6) weeks group with small birth weight was significantly higher than that in the<32 weeks group and 32-33+6 weeks group[54.2%(39/72)vs 20.0%(3/15),19.5%(8/41)],the differences were statistically significant(all P<0.017).Conclusion The risk of late premature infants with BWDT is higher.The placental and umbilical cord factors play an important role in the occurrence of BWDT in early preterm infants,while gestational hypertension has a greater impact on the occurrence of BWDT in late preterm infants,and gestational hypertension can serve as an independent risk factor affecting the occurrence of BWDT.Early preterm infants with BWDT are more prone to feeding intolerance and brain damage in those with small birth weight,while late preterm infants have a higher risk of small for gestational age infant.
作者
魏贤
杨树杰
甘斌
蔡大芬
Wei Xian;Yang Shujie;Gan Bin;Cai Dafen(Department of Neonatology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Hubei,Xiaogan 432000,China;Department of Obstetrics,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Hubei,Xiaogan 432000,China)
出处
《发育医学电子杂志》
2025年第1期11-18,共8页
Journal of Developmental Medicine (Electronic Version)
基金
湖北省儿科联盟医学科研项目(HPAMRP202113)。
关键词
出生体质量不一致
双胎
早产
相关因素分析
并发症
Birth weight discordant
Twins
Premature birth
Analysis of relevant factors
Complication
作者简介
通信作者:杨树杰(Email:xgysj1969@126.com)。
