母体临床特征与血生化指标在双胎妊娠子痫 前期风险预测中的应用：现状与展望

Application of Maternal Clinical Characteristics and Blood Biochemical Markers in Risk Prediction of Preeclampsia in Twin Pregnancies: Current Status and Future Perspectives

摘要: 双胎妊娠子痫前期(PE)的发病率显著高于单胎妊娠，其病理生理机制涉及胎盘体积增大、血管生成因子失衡、母体心血管负荷增加及免疫调节异常等多重因素。与单胎PE不同，双胎PE表现出更早的发病年龄和更严重的临床表现，但其危险因素谱和预测模型研究相对滞后。本文系统综述了双胎PE的发病机制、基于母体临床特征(孕前体质指数、孕期增重、受孕方式、绒毛膜性等)和血生化指标(胎盘生长因子、可溶性fms样酪氨酸激酶-1、妊娠相关血浆蛋白A、游离胎儿DNA分数等)的预测因子研究进展，总结了国内外双胎PE预测模型的构建现状与效能评价。现有研究表明，单一指标预测效能有限，多指标联合模型可显著提升预测准确性，但多数模型样本量较小、缺乏外部验证。未来研究应致力于多中心大样本队列的建立、多模态预测模型的优化、机器学习算法的应用以及临床决策支持系统的开发，以实现双胎PE的精准早期筛查和个体化管理。

Abstract: The incidence of preeclampsia (PE) in twin pregnancies is significantly higher than that in singleton pregnancies. Its pathophysiology involves multiple factors, including increased placental volume, imbalance of angiogenic factors, increased maternal cardiovascular load, and immune dysregulation. Unlike singleton PE, twin PE presents with earlier onset and more severe clinical manifestations, yet research on its risk factor profile and predictive models lags behind. This article systematically reviews the pathogenesis of twin PE, the progress of predictive factors based on maternal clinical characteristics (pre-pregnancy body mass index, gestational weight gain, mode of conception, chorionicity, etc.) and blood biochemical markers (placental growth factor, soluble fms-like tyrosine kinase-1, pregnancy-associated plasma protein A, cell-free fetal DNA fraction, etc.), and summarizes the current status and performance evaluation of predictive models for twin PE in China and internationally. Existing studies show that single indicators have limited predictive efficacy, while multi-indicator combined models significantly improve predictive accuracy. However, most models have small sample sizes and lack external validation. Future research should focus on establishing multicenter large-sample cohorts, optimizing multimodal prediction models, applying machine learning algorithms, and developing clinical decision support systems to achieve accurate early screening and individualized management of twin PE.