双胎早产儿支气管肺发育不良危险因素分析：一项多中心研究

Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study

摘要:

目的 分析胎龄<34周双胎早产儿发生支气管肺发育不良（bronchopulmonary dysplasia, BPD）的危险因素，为临床早期识别双胎早产儿BPD的发生提供依据。方法 回顾性收集全国22家医院2018年1月—2020年12月收治的胎龄<34周双胎早产儿，根据双胎儿患病情况分为三组：两胎均为BPD组、仅一胎为BPD组、两胎均非BPD组，分析双胎早产儿发生BPD的危险因素；并对仅一胎为BPD组患儿进一步分析，组内配对分析双胎早产儿发生BPD的产后危险因素。结果 共纳入胎龄<34周的双胎儿共904对。多因素logistic回归分析中，与两胎均非BPD组相比，双胎出生体重差异>25%是双胎中仅一胎患BPD的危险因素 （OR=3.370，95%CI：1.500~7.568，P<0.05），胎龄大是双胎均患BPD的保护因素（P<0.05）。对双胎中仅一胎为BPD组进行组内条件logistic回归分析，提示小于胎龄儿是双胎内个体发生BPD的危险因素（OR=5.017，95%CI：1.040~24.190，P<0.05）。结论 双胎早产儿BPD的发生不仅与胎龄相关，也与双胎出生体重差异、小于胎龄儿密切相关。

Abstract:

Objective To investigate the risk factors for bronchopulmonary dysplasia (BPD) in twin preterm infants with a gestational age of <34 weeks, and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of <34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020. According to their conditions, they were divided into group A (both twins had BPD), group B (only one twin had BPD), and group C (neither twin had BPD). The risk factors for BPD in twin preterm infants were analyzed. Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of <34 weeks were included in this study. The multivariate logistic regression analysis showed that compared with group C, birth weight discordance of >25% between the twins was an independent risk factor for BPD in one of the twins (OR=3.370, 95%CI: 1.500-7.568, P<0.05), and high gestational age at birth was a protective factor against BPD (P<0.05). The conditional logistic regression analysis of group B showed that small-for-gestational-age (SGA) birth was an independent risk factor for BPD in individual twins (OR=5.017, 95%CI: 1.040-24.190, P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age, birth weight discordance between the twins, and SGA birth.