Page 84 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第6期
·862 · Journal of Nanjing Medical University（Natural Sciences） 2021年6月

·临床医学·

双胎妊娠发生早产的危险因素及其预测模型的构建

朱金改，陈玉林 ，韩树萍，余章斌
*
南京医科大学附属妇产医院（南京市妇幼保健院）儿科，江苏 南京 210004

［摘 要］ 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（receiv⁃
er 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。
［关键词］ 双胎；早产；危险因素；Logistic回归；ROC曲线
［中图分类号］ R714.21 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）06⁃862⁃07
doi：10.7655/NYDXBNS20210611

Risk factors for preterm twin pregnancy and establishment of predictive model

*
ZHU Jingai，CHEN Yulin ，HAN Shuping，YU Zhangbin
Department of Pediatrics，the Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University（Nanjing
Maternity and Child Health Care Hospital），Nanjing 210004，China

［Abstract］ 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 for
29% ，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

［基金项目］ 江苏省医学青年人才（QNRC2016114）；南京医科大学“专病队列”资助项目（NMUC2020037）；南京市医学科技发
展基金（ZKX19045）
∗
通信作者（Corresponding author），E⁃mail： chenyulin2010@126.com