双胎妊娠发生早产的危险因素及其预测模型的构建

Risk factors for preterm twin pregnancy and establishment of predictive model

目的:探讨双胎妊娠发生早产的危险因素,并构建预测模型。方法:回顾性分析2017年1月—2019年12月在南京医科大学附属妇产医院分娩的双胎妊娠临床资料,根据分娩孕周分为早产组(<37周)和足月组(≥37周),单因素分析两组孕产妇一般情况、妊娠期合并症及并发症,多因素Logistic回归分析双胎妊娠早产的独立危险因素,并应用受试者操作特征(receiver operating characteristic,ROC)曲线评价所建立模型的预测价值。结果:共纳入双胎妊娠孕产妇1 783例,早产组856例,足月组927例,早产发生率为48%。早产原因中医源性早产占43%,胎膜早破占29%,自发性早产占28%。早产组不规律产检、单绒毛膜性、双胎发育不一致、瘢痕子宫、胎膜早破、妊娠期高血压疾病、羊水异常、肝内胆汁淤积症、胎儿宫内窘迫、绒毛膜羊膜炎比例均高于足月组,差异有统计学意义(P <0.05)。多因素Logistic回归分析显示,双胎发育不一致、不规律产检、单绒毛膜性、肝内胆汁淤积症、羊水异常、妊娠期高血压疾病、胎膜早破、胎儿宫内窘迫、绒毛膜羊膜炎及瘢痕子宫是双胎妊娠发生早产的独立危险因素(P <0.05)。ROC曲线验证该模型诊断效能较高。结论:双胎妊娠早产的发生与多种母体和胎儿的危险因素有关,其发生率高,可根据危险因素的数量初步筛选双胎妊娠发生早产的高危人群。

Objective:This study aims to investigate the risk factors of preterm twin pregnancy and establishment of predictive model. Methods:Twin pregnant women delivered in the Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University from January 2017 to December 2019 were analyzed retrospectively,who were divided into preterm group(<37 weeks)and term group(≥37 weeks)according to the gestational week of delivery. Univariate analysis was used to analyze the general conditions,pregnancy complications of the two groups. Multivariate logistic regression analysis was used to analyze the independent risk factors of preterm in twin pregnancy. ROC curve was used to evaluate the predictive value. Results:A total of 1 783 pregnant women with twin pregnancy,856 in the preterm group,and 927 in the term group were collected,the incidence of preterm birth was 48%. Causes of preterm labor in the twin pregnancy were listed at below:iatrogenic preterm labor accounted for 43%,premature rupture of membranes accounted for29%,and spontaneous preterm labor accounted for 28%. Irregular prenatal examination,monochorionic twins,discordant twins,cicatrical ulerus,premature rupture of membranes,hypertension in pregnancy,abnormal amniotic fluid,intrahepatic cholestasis,intrauterine distress,and chorioamnionitis in the preterm group were higher than those in the control group,and the differences were statistically significant(P < 0.05). Multivariate logistic regression analysis showed that discordant twins,irregular prenatal examination,monochorionic twins,intrahepatic cholestasis,abnormal amniotic fluid,hypertensive disorder complicating pregnancy,premature rupture of membranes,intrauterine distress,chorioamnionitis and cicatrical ulerus were the independent risk factors of preterm twin pregnancy. The ROC curve verified the high predictive efficiency of the model. Conclusion:The occurrence of preterm birth in twin pregnancy is related to a variety of maternal and fetal risk factors. The incidence of preterm twin pregnancy is fairly high and could be predicted from the risk factors.