在早产双胞胎中,血液动力学上显著的专利动脉管和布洛芬治疗失败的危险因素:一个回顾性病例控制研究
Bo Gao1, Yixue Zhao2, Huixian Li3,4,5
1Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
选择性子宫内生长限制 (sIUGR) 是早产双胞胎中血液动力学显著的专利导管动脉 (hsPDA) 的危险因素. 双胞胎和长期早产膜破裂 (PROMs) 会增加布洛芬治疗失败的风险.
科学领域:
- 新生儿科学 新生儿科学
- 周围生理学 周围生理学
- 儿童心脏病学 儿童心脏病学
背景情况:
- 过早出生的双胞胎有高血动力学显著的专利动脉管 (hsPDA) 和对ibuprofen的反应不佳.
- 目前的管理策略是基于单元数据,并没有解决双胞胎的独特风险.
- 这项研究调查了hsPDA和伊布洛芬治疗失败的风险因素,以个性化预防和治疗.
研究的目的:
- 确定早产双胞胎hsPDA的独立风险因素.
- 确定早产双胞胎布洛芬治疗失败的独立风险因素.
- 为了检查hsPDA发生和ibuprofen治疗失败的潜在生物标志物.
主要方法:
- 一项回顾性病例控制研究包括736名在妊娠34周或之前出生的双胞胎婴儿.
- 使用多变量逻辑回归来确定hsPDA和ibuprofen治疗失败的独立风险因素.
- 生物标志物水平 (NT-proBNP,Hs-cTn,PGE2,皮质醇,TXA2) 被检查与sIUGR相关.
主要成果:
- 选择性子宫内生长限制 (sIUGR) 是hsPDA的一个独立风险因素 (OR=3.337). 较高的出生体重具有保护性 (OR=0.537).
- 双胞胎 (OR=4.686) 和早产膜破裂 (PROMs) >18小时 (OR=15.198) 是布洛芬治疗失败的独立风险因素.
- MCDA 双胞胎的关闭率较低,需要更高的药物剂量,并接受了更多的手术干预. 在SIUGR组中观察到高NT-proBNP和Hs-cTn.
结论:
- 在早产双胞胎 (≤34周) 中,sIUGR 是 hsPDA 的独立风险因素.
- 双胞胎MCDA和PROM>18小时是布洛芬治疗失败的独立风险因素.
- 升高的NT-proBNP和Hs-cTn可能与sIUGR的早产婴儿hsPDA的发展有关.
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