联体双胎患儿的预后及其危险因素分析

Prognosis and risk factors of conjoined twins

目的了解广西地区联体双胎患儿生存情况,分析影响联体双胎患儿预后的主要危险因素。方法回顾性分析2015年1月至2020年12月广西壮族自治区建档产前筛查或产后分娩检出联体双胎共90例产妇的临床资料,其中死胎、死产和出生7 d内死亡78例,出生7 d后存活12例,比较死亡组和生存组产妇的临床资料,采用多因素Logistic回归分析联体双胎患儿死亡的风险因素。结果广西地区联体双胎生存率较低(13.33%)。存活组和死亡组患儿产妇的年龄[(24.75±2.90)岁vs(27.49±5.03)岁]和流产次数[0.50(0.00,1.00)次vs 1.00(1.00,2.00)次]比较,存活组明显低于死亡组,胎儿体质量[3300.00(1125.00,4700.00)g vs 500.00(287.50,1000.00)g]、超声确诊率(75.0%vs 6.4%)和产前诊断率(83.3%vs 16.7%)比较,存活组明显高于死亡组,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,诊断方式和是否产前诊断是影响联体双胎患儿预后的独立危险因素(P<0.05)。结论广西地区联体双胎患儿生存率较低,诊断方式和是否产前诊断是影响患儿预后的独立危险因素,孕期需加强影像学检查以早期诊断和干预疾病,改善患者预后。

Objective To investigate the survival status of conjoined twins in Guangxi,and to analyze the main prognostic risk factors of conjoined twins.Methods The clinical data of 90 puerperas with conjoined twins detected through prenatal screening or postpartum delivery from Jan.2015 to Dec.2020 in Guangxi were reviewed retrospective-ly,of which 78 cases(with stillbirth,stillborn,and neonates died within 7 days after birth)were categorized as fetal death group and 12 cases(with neonates not died within 7 days after birth)were categorized as survival group.The clini-cal characteristics of the puerperas were compared between survival group and fetal death group.Multivariate logistic re-doi pression was used to evaluate the risk factors for conjoined twins.Results The survival rate of conjoined twins from 2015 to 2020 in Guangxi was low(13.33%).The age and previous abortions of the puerperas in the survival group were significantly lower than those in fetal death group(P<0.05):age,(24.75±2.90)years vs(27.49±5.03)years;previous abortions,0.50(0.00,1.00)times vs 1.00(1.00,2.00)times.Neonatal weight,ultrasonic diagnosis rate,and prenatal diag-nosis rate of survival group were significantly higher than those in fetal death group(P<0.05):neonatal weight,3300.00(1125.00,4700.00)g vs 500.00(287.50,1000.00)g;ultrasonic diagnosis rate,75.0%vs 6.4%;and prenatal diagnosis rate,83.3%vs 16.7%.Logistic regression analysis revealed that diagnostic method and prenatal diagnosis were signifi-cant risk factors affecting the prognosis of conjoined twins(P<0.05).Conclusion The survival rate of conjoined twins was relatively low in Guangxi.Diagnostic method and prenatal diagnosis were significant risk factors affecting the prog-nosis of conjoined twins.Imaging examination should be implemented for early diagnosis and intervention of diseases,and thus to improve the prognosis.