摘要目的 了解单绒毛膜双羊膜囊(monochorionic diamniotic,MCDA)出生体重不一致双胎从出生至24月龄的体格生长状况. 方法 回顾性分析2010年1月1日至2016年6月30日在中山大学附属第一医院分娩且存活的31对(62例胎儿)MCDA出生体重不一致双胎(出生体重差≥25％)的临床资料,以及从出生至24月龄体格生长情况.不一致双胎中,出生体重较高的活产儿为重出生体重组(31例),出生体重较低的活产儿为轻出生体重组(31例).采用x2检验、配对t检验、方差分析及LSD-t检验对数据进行统计分析. 结果 (1)轻出生体重组出生缺陷和低蛋白血症的发生率均高于重出生体重组[分别为29.0％ (9/31)与0.0％(0/31)、54.8％(17/31)与25.8％ (8/31),x2值分别为8.319和5.429,P值均＜0.05].(2)轻出生体重组在出生及1、6、12、18、24月龄的体重、身长和头围标准差评分(standard deviation score,SDS)均低于重出生体重组[出生:分别为(-2.00±0.66)与(-0.04±0.60)、(-1.83±1.13)与(-0.37±0.83)、(-1.42±1.03)与(0.17±0.84),t值分别为17.214、8.390及7.759;1月龄:(-1.77±0.81)与(-0.60±0.65)、(-2.36±1.20)与(-0.94±0.74)、(-1.71±1.26)与(-0.44±1.09),t值分别为9.424、9.059及7.197;6月龄:(-1.00±0.84)与(-0.09±0.56)、(-1.31±1.22)与(-0.04±0.80)、(0.30±1.51)与(1.11±1.20),t值分别为7.578、7.988及6.091;12月龄:(-0.34±1.06)与(0.47±0.79)、(-1.00±0.92)与(-0.14±0.73)、(-0.16±0.76)与(0.49±0.58),t值分别为5.747、7.155及5.664;18月龄:(-0.06±0.95)与(0.74±0.66)、(-0.92±1.07)与(-0.24±0.92)、(-0.32±0.72)与(0.29±0.66),t值分另别为6.153、4.496及3.877;24月龄:分别为(0.20±0.79)与(0.88±0.62)、(-0.66±0.59)与(0.01±0.67)、(-0.37±0.60)与(0.34±0.68),t值分别为5.317、4.800及4.905;P值均＜0.001];但是体重、身长和头围出生至24月龄SDS增长值(△SDS)及追赶生长(△SDS＞0.67)发生率均高于重出生体重组[△SDS:分别为(2.20±1.10)与(0.92±0.91)、(1.17±1.21)与(0.37±1.14)、(1.05±1.07)与(0.16±0.89),t值分别为8.422、3.918及3.547,P值均＜0.001;△SDS＞0.67:93.5％ (29/31)与61.3％(19/31)、61.3％ (19/31)与35.5％ (11/31)、61.3％ (19/31)与29.0％ (9/31),x2值分别为9.226、4.133及6.531,P值均＜0.05].(3) 24月龄双胎中重出生体重个体与轻出生体重个体的体重、身长和头围SDS差值与出生时比较均降低[分别为(0.68±0.71)与(1.95±0.63)、(0.67±0.77)与(1.46±0.97)、(0.71±0.80)与(1.60±1.1 5);P值均＜ 0.05]. 结论 MCDA出生体重不一致双胎从出生到24月龄体格生长存在差异,但是24月龄的体格生长差异较出生时缩小.

abstractsObjective To assess the growth of monochorionic diamniotic (MCDA) twins discordant for birth weight during their first 24 months of life.Methods Clinical data and growth parameters from birth to 24 months of age of 31 pairs(62 cases) of birth weight-discordant MCDA twins (≥ 25％ difference in birth weight) who were born alive in the First Affiliated Hospital,Sun Yat-sen University between January 1,2010 and June 30,2016 were retrospectively analyzed.Each pair of twins was divided into the large birth weight group (31 cases) and the small birth weight group (31 cases).All datas were statistically analyzed with Chisquare test,paired t test,analysis of variance or LSD-t test.Results (1) The incidence of birth defects and hypoproteinemia in the small birth weight group were higher than that in the large birth weight group [29.0％ (9/31) vs 0.0％ (0/31),54.8％ (17/31) vs 25.8％ (8/31);x2=8.319 and 5.429;both P ＜ 0.05].(2) The standard deviation scores (SDS) of weight,length and head circumference at birth and 1,6,12,18 and 24 months of age of the small birth weight group were lower than those of the large birth weight group [birth:(-2.00 ± 0.66) vs (-0.04±0.60),(-1.83±1.13) vs (-0.37±0.83),(-1.42±1.03) vs (0.17±0.84),t=17.214,8.390 and 7.759;1 month:(-1.77±0.81) vs (-0.60±0.65),(-2.36±1.20) vs (-0.94±0.74),(-1.71±1.26) vs (-0.44± 1.09),t=9.424,9.059 and 7.197;6 months (-1.00±0.84) vs (-0.09±0.56),(-1.31 ± 1.22) vs (-0.04±0.80),(0.30±1.51) vs (1.11 ± 1.20),t=-7.578,7.988 and 6.091;12 months:(-0.34±1.06) vs (0.47±0.79),(-1.00±0.92) vs (-0.14±0.73),(-0.16±0.76) vs (0.49±0.58),t=5.747,7.155 and 5.664;18 months:(-0.06±0.95) vs (0.74±0.66),(-0.92± 1.07) vs (-0.24±0.92),(-0.32±0.72) vs (0.29±0.66),t=6.153,4.496 and 3.877;24 months:(0.20±0.79) vs (0.88±0.62),(-0.66±0.59) vs (0.01 ±0.67),(-0.37±0.60) vs (0.34±0.68),t=5.317,4.800 and 4.905;all P ＜ 0.001].However,the changes in SDS (△ SDS) of weight,length and head circumference from birth to 24 months of age and the incidence of △ SDS ＞ 0.67 were significantly higher in the small birth weight group than those in the large birth weight group [△SDS:(2.20± 1.10) vs (0.92±0.91),(1.17± 1.21) vs (0.37± 1.14),(1.05± 1.07) vs (0.16±0.89),t=8.422,3.918 and 3.547,all P ＜ 0.001;△SDS ＞ 0.67:93.5％ (29/31) vs 61.3％ (19/31),61.3％ (19/31) vs 35.5％ (11/31),61.3％ (19/31) vs 29.0％ (9/31),x2=9.226,4.133 and 6.53 1,all P ＜ 0.05].(3) The difference in SDS for weight,length and head circumference between the large and small birth weight twins at 24 months of age were significantly lower than those at birth [(0.68 ± 0.71) vs (1.95 ± 0.63),(0.67 ± 0.77) vs (1.46± 0.97),(0.71 ± 0.80) vs (1.60±1.15);all P ＜ 0.05].Conclusions Growth differences are found between birth weight-discordant MCDA twins all the way to 24 months of age from birth at a reduced trend.