目的:低出生体重可能在以后的生活中产生不良后遗症。因此,我们分析了由于双胎对双胎输血综合征(TTTS)导致双胎间出生体重差异的单卵双胞胎的行为困难和唾液糖皮质激素谱.
方法:招募了46对出生体重差异<1SDS(一致;n=29)和≥1SDS(不一致;n=17)的单卵TTTS双胞胎,平均年龄为6.9岁,进行前瞻性纵向队列研究。对于糖皮质激素分析,收集唾液样本(在7小时,13h,18h和21h),并用液相色谱-串联质谱法进行分析。家长填写了“优势和困难问卷”。
结果:从父母的角度来看,以前较小的双胞胎在多动症(平均4.63vs3.48,p=0.003)和情绪问题(平均2.67vs2.02,p=0.042)方面得分较高。较小的双胞胎的追赶生长较少(4岁的双胞胎身高SDSΔ-双胞胎出生长度SDSΔ)与多动症得分较高有关(Adj.R²=0.261,p<0.001,β=-1.88,F(1.44)=16.86,n=46,f²=0.35),而出生体重较小(Adj.R²=0.135,p=0.007,β=-0,87,F(1.44)=8.03,n=46,f²=0.16)和出生长度(Adj.R²=0.085,p=0.028,β=-0,78,F(1.44)=5.19,n=46,f²=0.09)与同伴问题的较高得分相关。皮质醇的Δ内孪生更大(7h:rho=0.337,p=0.029;累积:rho=0.458;p=0.024)和可的松(7h:rho=0.329,p=0.029;13h:rho=0.436,p=0.005)与行为问题的Δ内孪生更大相关。在不和谐的群体中,头围约1SDS从出生时持续存在(平均SDS:较小的双胞胎-1.18,较大的双胞胎-0.08,p<0.001)到现在(平均SDS:较小的双胞胎-1.16,较大的双胞胎-0.14,p<0.001)。
结论:小双胞胎中皮质醇和可的松浓度较高与品行问题评分较高相关。较低的出生体重和缺乏追赶生长影响了父母对小双胞胎行为的看法。他们认为那些孩子更加活跃,更多的同龄人问题和情绪问题。因此,在可以评估行为困难的地方进行定期检查似乎很重要,可以向家庭提供帮助和建议。由于较小的不和谐双胞胎中持续较小的头围,这应该定期测量。
OBJECTIVE: Low birthweight may have adverse sequelae in later life. Therefore, we analyzed behavioral difficulties and salivary glucocorticoid profiles in monozygotic twins with intra-twin birthweight differences due to twin-to-twin transfusion syndrome (TTTS).
METHODS: 46 monozygotic TTTS twin pairs with birthweight differences of <1SDS (concordant; n=29) and ≥1SDS (discordant; n=17) were recruited at a mean age of 6.9 years for a prospective longitudinal cohort
study. For glucocorticoid analysis, saliva samples were collected (at 7 h, 13 h, 18 h and 21 h) and analyzed with liquid chromatography-tandem mass spectrometry. Parents completed the Strengths and Difficulties Questionnaire.
RESULTS: From the parents\' perspective, the formerly smaller twins had statistically higher scores regarding hyperactivity (mean 4.63 vs 3.48, p=0.003) and emotional problems (mean 2.67 vs 2.02, p=0.042). Less catch-up growth (Δintra-twin height SDS 4 years of age - Δintra-twin birth length SDS) of the smaller twins was associated with higher scores for hyperactivity (Adj. R²=0.261, p<0.001, β=-1.88, F(1.44)=16.86, n=46, f²=0.35), while smaller birthweight (Adj. R²=0.135, p=0.007, β=-0,87, F(1.44)=8.03, n=46, f²=0.16) and birth length (Adj. R²=0.085, p=0.028, β=-0,78, F(1.44)=5.19, n=46, f²=0.09) were associated with higher scores for peer problems. Greater Δintra-twin for cortisol (7 h: rho=0.337, p=0.029; cumulative: rho=0.458; p=0.024) and cortisone (7 h: rho=0.329, p=0.029; 13 h: rho=0.436, p=0.005) correlated with a greater Δintra-twin for conduct problems. In the discordant group, circa 1 SDS in head circumference persisted from birth (mean SDS: smaller twin -1.18, larger twin -0.08, p<0.001) to present (mean SDS: smaller twin -1.16, larger twin -0.14, p<0.001).
CONCLUSIONS: Higher cortisol and cortisone concentrations in smaller twins were associated with higher scores for conduct problems. Lower birthweight and absent catch-up growth affected the parents\' perspective on the smaller twins\' behavior. They saw those children as more hyperactive, with more peer problems and emotional problems. Thus, it seems important to introduce regular check-ups where behavioral difficulties can be assessed, and assistance and advice can be given to the families. Due to the persisting smaller head circumference in the smaller discordant twins, this should be measured regularly.