皮质类固醇在双胎妊娠晚期早产中应用的研究进展

doi:10.12280/gjfckx.20260100

摘要/Abstract

摘要：

双胎妊娠早产率为47.6%~69.0%，其中晚期早产率33.0%~59.8%，显著高于单胎妊娠。产前皮质类固醇（antenatal corticosteroids，ACS）在妊娠34周前使用能有效降低新生儿死亡等并发症，而在晚期早产中的应用存在争议，尤其在双胎妊娠中。多数研究支持ACS能降低双胎妊娠晚期早产儿发生呼吸窘迫综合征等呼吸系统并发症，但部分研究发现两者并无明确关联，且效果不及单胎妊娠。ACS对双胎妊娠晚期早产儿远期神经系统发育的影响尚未明确，部分证据提示可能增加认知发育延迟、注意力缺陷以及多动障碍等，动物实验也验证了ACS潜在神经损伤机制。同时ACS可增加双胎妊娠晚期早产儿低血糖风险，低血糖与远期神经发育异常也存在潜在关联。目前国内外指南对双胎妊娠晚期早产常规使用ACS缺乏共识，大多建议个体化决策。

关键词: 妊娠，双胎, 婴儿，早产, 晚期早产, 肾上腺皮质激素类, 呼吸系统, 低血糖症, 神经系统

Abstract:

The preterm birth rate in twin pregnancies is 47.6%-69.0%, with the late preterm birth rate ranging from 33.0% to 59.8%, which is significantly higher than in singleton pregnancies. The use of antenatal corticosteroids (ACS) before 34 weeks of gestation can effectively reduce complications such as neonatal mortality, but its application in late preterm birth is controversial, especially in twin pregnancies. Most studies support that ACS can reduce respiratory complications such as respiratory distress syndrome in late preterm neonates from twin pregnancies. However, some studies find no clear association between them, and the effect is inferior to that in singleton pregnancies. The long-term impact of ACS on the neurological development of late preterm infants from twin pregnancies is not yet clear. Some evidence suggests a possible increased risk of cognitive developmental delays, attention deficits, and hyperactivity disorders. Animal experiments have also verified the potential neuroinjury mechanisms of ACS. Concurrently, ACS may increase the risk of hypoglycemia in late preterm infants from twin pregnancies, and hypoglycemia also has a potential association with long-term neurodevelopmental abnormalities. Currently, there is a lack of consensus in both domestic and international guidelines regarding the routine use of ACS in late preterm twin pregnancies, with most recommending individualized decision-making.

Key words: Pregnancy, twin, Infant, Premature, Late preterm birth, Adrenal cortex hormones, Respiratory system, Hypoglycemia, Nervous system

娄颖亚, 高娟妹, 翟洪波. 皮质类固醇在双胎妊娠晚期早产中应用的研究进展[J]. 国际妇产科学杂志, 2026, 53(3): 249-254.

LOU Ying-ya, GAO Juan-mei, ZHAI Hong-bo. Research Progress on the Application of Corticosteroids in Late Preterm Twin Pregnancies[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 249-254.

图/表 2

图1 ACS降低RDS发生的机制图注：糖皮质激素可刺激Ⅱ型肺泡上皮细胞，上调表面活性物质的合成与分泌，从而稳定肺泡；糖皮质激素通过抑制炎症通路并调节细胞外基质及胶原蛋白基因表达；还可降低血管通透性，增加肺顺应性和最大肺容积，减轻肺部炎症与水肿。

图2 ACS促使新生儿低血糖的机制图注：糖皮质激素透过胎盘屏障，高血糖水平刺激胎儿胰岛β细胞增殖并引发高胰岛素血症，出生后，胎盘的葡萄糖供应突然中断，但胰岛素水平仍居高不下，促使葡萄糖进入组织，导致新生儿短暂性低血糖；其还可抑制胎儿肾上腺轴，抑制胎儿肾上腺皮质激素的合成与分泌，而肾上腺皮质激素具有促进糖异生、升高血糖的作用，其分泌不足会导致新生儿糖异生能力下降。

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