双胎发育不一致性的相关因素分析

Correlation risk factors analysis of twins growth discordance

目的探讨影响双胎发育不一致性的相关因素。方法将120例双胎妊娠对象按新生儿体重差异≥25%为界值分成两组,分析对比孕产妇年龄、分娩前BMI等一般情况、分娩孕周、是否辅助生殖术后受孕、双胎绒毛膜类型、孕11-13+6周B超胎儿颈项透明层厚度(NT)值、头臀径(CRL)及妊娠合并糖尿病等合并症与新生儿体重差异是否存在相关性。两组间比较应用χ2检验、t检验;计量资料之间的比较采用相关分析,并通过多因素Logistic回归分析影响双胎发育不一致性的相关因素。结果单绒毛膜类型双胎的体重差异值高于双绒毛膜类型双胎的体重差异值,两者差异有统计学意义(t=2.169,P=0.032)。双胎体重差异大小与孕妇的分娩孕周存在负相关性(r=-0.332,P=0.001);与胎儿的NT差异存在正相关性(r=0.310,P=0.003);与孕妇的年龄、BMI及CRL差异未发现存在相关性。多变量逐步logistic回归分析发现分娩孕周是发生双胎体重差异的保护因素(OR=0.821,95%CI=0.668-1.023,P=0.073),而NT差异是发生双胎体重差异的危险因素(OR=389.575,95%CI=269.429-612.203,P=0.012)。结论对于NT差值较大的双胎妊娠孕妇,可能存在早期双胎发育不一致的倾向或表现,尤其对于单绒毛膜双羊膜囊双胎,胎儿体重容易出现更明显差异。应密切监护双胎发育,根据孕周,两胎儿体重差异程度及多普勒血流改变做出相应临床干预,以提高围产儿存活率。

Objective To exploring the related factors affecting twins growth discordance.Methods Totally 120 women with twin pregnancy were divided into two groups with greater than or equal to 25% difference in neonatal weight as a cut-off.The general situation such as maternal age,BMI before delivery,gestational age of childbirth,with or without assisted reproduction postoperative conception,the type of chorionic twin pregnancy,the fetal nuchal translucency（NT） thickness ultrasound scan index at 11-13＋6 weeks,Crown-Rump Length（CRL） and pregnancy associated complications,such as gestational diabetes mellitus,were analyzed and compared in order to explore whether there was any correlation between these factors and twins neonatal weight difference.Results The difference in weight between monochorionic twins is much higher than that between dichorionic twins.There was a negative correlation between the twin neonatal weight differences and gestational weeks（r=-0.332,P=0.001）;There was a positive correlation between the difference in twin neonatal weight and difference in NT value（r=0.310,P=0.003）;And there was no correlation among the difference in twin neonatal weight,the maternal age and the BMI results of pregnant woman or CRLdifferences.Multivariate stepwise logistic regression analysis showed that gestational age was a protective factor for twin weight difference（OR=0.821,95% CI=0.668-1.023,P=0.073）,while NT difference was a risk factor for twin weight difference（OR=389.575,95% CI=269.429-612.203,P=0.012）.Conclusion For twin pregnant women with large NT difference,there may betendencies or manifestations of early twins growth discordance especially for the monochorionic twin as fetal weight is easy to appear more obvious difference.Double fetal development should be closely monitored and,according to the gestational age,neonatal weight difference and umbilical artery Doppler flow changes to make corresponding clinical intervention,so as to lower the perinatal mortality rate.