目的 探讨双胎妊娠发育不一致的独立危险因素及新生儿期主要合并症.方法 收集2011年11月1日至2016年10月31日于北京大学人民医院产科分娩的152例(76对)双胎发育不一致新生儿及552例(276对)双胎发育一致的新生儿资料.比较2组母亲孕期及围生期情况和新生儿期合并症情况,采用Logistic回归分析双胎发育不一致的独立危险因素.结果 1.双胎发育不一致组新生儿胎龄、足月儿发生率、出生体质量均明显低于双胎发育一致组[(35.8±2.5)周比(36.7±1.8)周,48.7％比60.2％,(2 277.1±575.7)g比(2 545.0±413.4)g],差异均有统计学意义(均P＜0.05);早产儿发生率、小于胎龄儿发生率、转儿科率明显高于双胎发育一致组(51.3％比39.9％,40.8％比13.2％,46.1％比26.8％),差异均有统计学意义(均P＜0.05).2.双胎发育不一致组新生儿窒息、新生儿呼吸窘迫综合征、新生儿肺炎、新生儿呼吸暂停、支气管肺发育不良等呼吸系统合并症及新生儿脓毒症、新生儿颅内出血发生率均明显高于双胎发育一致组(6.6％比2.5％,7.2％比3.1％,5.3％比1.3％,9.2％比3.3％,3.9％比0.9％,3.3％比0.7％,4.6％比0.7％),差异均有统计学意义(均P ＜0.05).3.双胎发育不一致新生儿中低体质量组出生体质量明显低于高体质量组[(1 926.7±414.1)g比(2618.7 ±504.6)g],小于胎龄儿发生率、转儿科率、新生儿颅内出血发生率明显高于高体质量组(65.8％比6.6％,56.6％比35.5％,9.2％比0),差异均有统计学意义(均P＜0.05).4.Logistic回归分析显示,妊娠期高血压病(OR=2.127,95％CI:1.392 ～3.253)及妊娠期糖尿病(OR=1.684,95％ CI:1.112 ～2.552)是双胎发育不一致的独立危险因素.结论 母妊娠期高血压病及妊娠期糖尿病为双胎发育不一致的独立危险因素,双胎发育不一致新生儿期合并症发生率高,应重视及加强对双胎发育不一致新生儿尤其是低体质量儿的胎儿期及新生儿期监护及干预.%Objective To investigate the perinatal independent risk factors and neonatal complications of discordant twins.Methods Clinical data of 152 (76 pairs) discordant twins and 552 (276 pairs) concordant twins were enrolled at the Obstetrics of Peking University People's Hospital from November 1,2011 to October 31,2016.The perinatal characteristics and the neonatal complications in 2 groups were analyzed and compared.Binary Logistic regression analysis was used to identify the independent risk factors associated with the occurrence of discordant twins.Results (1) The gestational age,the incidence of term infants and birth weight of the discordant twins were significantly lower than those of the concordant twins[(35.8 ±2.5) weeks vs.(36.7 ± 1.8) weeks,48.7％ vs.60.2％,(2 277.1 ± 575.7) g vs.(2 545.0 ± 413.4) g],and the differences were statistically significant (all P ＜ 0.05).The incidence of premature infants,the incidence of infants small for gestational age and the rate of transferring discordant twins to pediatric department were significantly higher than that of concordant twins (51.3％ vs.39.9％,40.8％ vs.13.2％,46.1％ vs.26.8％),and the differences were statistically significant (all P ＜ 0.05).(2) The incidence of neonatal asphyxia,neonatal respiratory distress syndrome,neonatal pneumonia,neonatal apnea,bronchopulmonary dysplasia,neonatal sepsis and neonatal intracranial hemorrhage were significantly higher than those of concordant twins (6.6％ vs.2.5％,7.2％ vs.3.1％,5.3％ vs.1.3％,9.2％ vs.3.3％,3.9％ vs.0.9％,3.3％ vs.0.7％,4.6％ vs.O.7％),and the differences were statistically significant(all P ＜ 0.05).(3) The birth weight in the twins with low body weight group was significantly lower than that in the twins with high body weight group [(1 926.7 ± 414.1) g vs.(2 618.7 ± 504.6) g],and the differences were statistically significant (P ＜ 0.05).The incidence of small for gestational age,the rate of conversion to pediatrics and the incidence of neonatal intracranial hemorrhage in the twins with low body weight group were significantly higher than those in the twins with high body weight group (65.8％ vs.6.6％,56.6％ vs.35.5 ％,9.2％ vs.0),and the differences were statistically significant (all P ＜ 0.05).(4) Logistic regression analysis showed that hypertensive disorder during pregnancy (OR =2.127,95％ CI:1.392-3.253) and gestational diabetes mellitus (OR =1.684,95％ CI:1.112-2.552) were independent risk factors for the occurrence of discordant twins.Conclusions Hypertensive disorder during pregnancy and gestational diabetes mellitus are independent risk factors for the occurrence of discordant twins,who are much more likely to develop various neonatal complications,particularly low-birth-weight infants.Timely surveillance and treatment of short-term complications and long-time follow-up are essential to discordant twins.
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