双胎绒毛膜性、出生胎龄、出生体质量不一致程度与新生儿结局分析

Effect of Chorionicity,Gestational Age at Birth and Birth Weight Discordance on Neonatal Outcomes in Twin Pregnancies

【目的】探讨双胎妊娠的单绒毛膜双羊膜囊(MCDA)和双绒毛膜双羊膜囊(DCDA)不同绒毛膜性、出生胎龄和出生体质量不一致程度与活产双胎新生儿结局的关系。【方法】回顾性分析2015年1月至2020年12月在中山大学附属第一医院住院分娩的MCDA和DCDA活产双胎新生儿临床资料,共纳入1504例。MCDA组和DCDA组分别为386例和1118例。采用t检验、秩和检验、χ2检验/Fish确切概率法比较两组新生儿结局;logistic回归分析绒毛膜性、出生胎龄、出生体质量不一致程度和性别对双胎新生儿结局的影响。出生体质量不一致程度≥25%双胎新生儿168例,MCDA组和DCDA组分别为96例和72例,logistic回归分析绒毛膜性、出生胎龄、双胎出生体质量低或高(小胎儿或大胎儿)和性别对新生儿结局的影响。【结果】在1504例活产双胎新生儿中MCDA组出生胎龄低于DCDA组(P=0.000)、MCDA组出生体质量不一致程度高于DCDA组(P=0.001);MCDA组出生窒息、呼吸窘迫综合征(RDS)、支气管肺发育不良(BPD)和败血症的发生率高于DCDA组(P=0.000,P=0.000,P=0.000,P=0.000);出生胎龄低分别是双胎新生儿出生窒息、RDS、BPD、败血症、坏死性小肠结肠炎(NEC)≥Ⅱ期、急性肾损伤(AKI)、视网膜病变(ROP)发生以及死亡的独立危险因素(P=0.000,P=0.000,P=0.000,P=0.000,P=0.011,P=0.000,P=0.000,P=0.000),出生体质量不一致程度高分别是双胎新生儿出生窒息、RDS、BPD、败血症和ROP发生的独立危险因素(P=0.045,P=0.000,P=0.000,P=0.004,P=0.017);绒毛膜性不是双胎新生儿各种疾病发生和死亡的独立危险因素(P值均>0.05)。在168例出生体质量不一致程度≥25%双胎新生儿中,出生胎龄低分别是其出生窒息、RDS、BPD、败血症和ROP发生的独立危险因素(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000),双胎的小胎儿分别是出生窒息和BPD发生的独立危险因素(P=0.013,P=0.001);绒毛膜性不是新生儿疾病发生的独立危险因素(P值均>0.05)。【结论】绒毛膜性不是双胎新生儿不良结局发生的独立危险因素,出生胎龄低和出生体质量不一致程度高是双胎新生儿不良结局的独立危险因素;出生体质量不一致程度≥25%双胎的小胎儿新生儿结局更差。

【Objective】To investigate the effect of chorionicity,gestational age at birth and birth weight discordance on neonatal outcomes in twin pregnancies.【Methods】We conducted a population-based retrospective study of monochori‐onic diamniotic(MCDA)twin pregnancies and dichorionic diamniotic(DCDA)twin pregnancies who were admitted in the First Affiliated Hospital,Sun Yat-sen University from January 2015 to December 2020.A total of 1504 live-born twins were included,with 386 cases in MCDA group and 1118 cases in DCDA groups,respectively.The comparison of neonatal outcomes between MCDA and DCDA twins was performed using t-test,Wilcoxon rank sum test,Chi-square test or Fish‐er’s exact test.Logistic regression was performed to evaluate the effects of chorionicity,gestational age at birth,birth weight discordance and sex on neonatal outcomes.There were 168 live-born twins affected by inter-twin birth weight dis‐cordance≥25%,with 96 cases in MCDA group and 72 cases in DCDA groups,respectively.Logistic regression was per‐formed to evaluate the effects of chorionicity,gestational age at birth,birth weight light or heavy(small twin or large twin)of the twin and sex on neonatal outcomes.【Results】Among the 1504 newborns,gestational age at birth was lower in MC‐DA group compared with DCDA group(P=0.000),and the degree of birth weight discordance was higher in MCDA group than that of the DCDA group(P=0.001).Birth asphyxia,respiratory distress syndrome(RDS),bronchopulmonary dys‐plasia(BPD),and sepsis were more frequency in MCDA group compared with DCDA group(P=0.000,P=0.000,P=0.000,P=0.000).Low gestational age at birth was an independent risk factor for birth asphyxia,RDS,BPD,sepsis,nec‐rotizing enterocolitis(NEC)≥stageⅡ,acute kidney injury(AKI),retinopathy of prematurity(ROP),and neonatal death respectively(P=0.000,P=0.000,P=0.000,P=0.000,P=0.011,P=0.000,P=0.000,P=0.000).High degree of birth weight discordance was an independent risk factor for birth asphyxia,RDS,BPD,sepsis and ROP respectively(P=0.045,P=0.000,P=0.000,P=0.004,P=0.017).Chorionicity was not an independent risk factor for neonatal morbidity and death(P>0.05).Among the 168 twins with birth weight discordance≥25%,low gestational age at birth was an independent risk factor for birth asphyxia,RDS,BPD,sepsis and ROP,respectively(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000);small twin was an independent risk factor for birth asphyxia and BPD,respectively(P=0.013,P=0.001);chorionicity was not an independent risk factor for neonatal morbidity(P>0.05).【Conclusion】Chori‐onicity was not an independent risk factor for adverse neonatal outcome in twin births.Low gestational age at birth and high degree of birth weight discordance were independent risk factor for adverse neonatal outcome in twin births.Small twins had increased risk of adverse neonatal outcome in twins with birth weight discordance≥25%.