双胎合并低蛋白血症不良妊娠结局分析

目的 探讨双胎妊娠合并低蛋白血症不良妊娠结局。方法 选取2011年1月至2015年12月安徽省妇幼保健院分娩无明显严重孕期并发症的双胎妊娠140例，将其中90例低蛋白血症患者设为观察组，按低蛋白血症诊断标准将90例患者分为重度低蛋白血症组（血清白蛋白<20 g/L，Ⅰ组，n=34）和轻度低蛋白血症组（20 g/L<血清白蛋白<30 g/L，Ⅱ组，n=56）；血清白蛋白正常的双胎妊娠50例纳入对照组。统计比较观察组及对照组产妇的一般临床资料、生化检查指标、妊娠不良结局等。结果 观察组患者生化指标、妊娠不良结局与对照组比较，肝肾功能及血脂损伤较对照组严重，差异有统计学意义（P<0.05）。两组孕产次，体质指数（BMI），自然受孕与否，不良妊娠史，绒毛膜性质等比较，差异均无统计学意义（P>0.05）。观察组组间（Ⅰ组和Ⅱ组）比较，Ⅰ组肝肾功能及血脂损伤较Ⅱ组严重，Ⅰ组产妇在胎盘早剥、产后出血、新生儿低体重、窒息发生率等不良妊娠结局发生率等方面显著高于Ⅱ组（P<0.05）。结论 随着低蛋白血症的出现及进展，产妇肝肾功能及血脂代谢损伤加重，双胎妊娠胎盘早剥、产后出血、产褥感染等并发症发病率增加，并可造成围生儿不良结局。

Analysis of the pregnancy outcome of twin pregnancy combined with hypoproteinemia

Objective To investigate the pregnancy outcome of twin pregnancy combined with hypoproteinemia. Methods From Jan 2011 to Dec 2015, 140 cases of twin pregnant women without severe gestation complications were collected and therein 90 cases with hypoproteinemia were enrolled in the study group. According to the diagnostic criteria of hypoproteinemia, they were further divided into the severe hypoproteinemia group (serum albumin <20 g/L, n=34) and the mild hypoproteinemia group (20 g/Ln=56). The rest 50 cases with normal albumin level were enrolled in the control group. The general clinical data, results of biochemical examinations and adverse pregnancy outcome between the twin pregnant women of two groups were analyzed and compared. Results The impairments of hepatic and renal function and abnormal lipid metabolism in the patients of study group were more severe than those in the control group in comparison with their biochemical examinations and adverse pregnancy outcome, with significant differences between the two groups (P<0.05). No difference was found in the times of gestation and delivery, BMI, natural conception or in vitro fertilization (IVF), adverse pregnancy history, chorionic conditions between them (P>0.05). In the subgroup comparison of study group, the severe hypoproteinemia group showed more severe impairments of hepatic and renal function and abnormal lipid metabolism than the mild hypoproteinemia group. Meanwhile, the occurrence of such adverse pregnancy outcome as placental abruption, postpartum hemorrhage, fetal growth restriction, and fetal distress in the severe hypoproteinemia group were significantly higher than those in the mild hypoproteinemia group (P<0.05). Conclusion With the onset and progress of hypoproteinemia, the twin pregnant women would suffer from worse impairments of hepatic and renal function and abnormal lipid metabolism, higher risk of such complications as placental abruption, postpartum hemorrhage and puerperal infection, and even perinatal twin adverse outcome.