twins, monozygotic

双胞胎,单合子
  • 文章类型: Journal Article
    目的:本研究旨在评估预测因子之间的不同途径,如接合性,非典型吞咽,嘴巴呼吸,母乳喂养和奶瓶喂养相关的前开放咬伤(AOB)的双胞胎。
    方法:这项研究是在3-15岁的单卵(MZ)和双卵(DZ)双胞胎儿童中进行的。AOB,非典型吞咽,嘴巴呼吸,喂养类型,瓶子使用的持续时间,在口腔检查期间记录睡眠期间的张口状态。进行了偏最小二乘结构方程模型(PLS-SEM)和sobel检验,以评估变量之间对AOB的总体和间接影响。
    结果:共有404名儿童(29.2%MZ;70.8%DZ)参加了这项研究。PLS-SEM模型中的接合度对口腔呼吸的影响具有统计学意义。相反,确定口呼吸影响非典型吞咽(p=0.001)。非典型吞咽触发AOB(p=0.001)。非典型吞咽在AOB和口腔呼吸之间具有中介作用(p=0.020)。口呼吸引起非典型吞咽,因此间接增加AOB的可能性。母乳喂养可降低AOB发生率(p=0.023),奶瓶喂养增加AOB发生率(p=0.046)。sobel测试表明,口腔呼吸的完全中介变量特征在接合性与非典型吞咽之间的负相关方面具有统计学意义。
    结论:PLS-SEM模型显示,口腔呼吸触发非典型吞咽,非典型吞咽触发AOB。由于这一连串的关系,观察到接合性对AOB的间接影响。根据Sobel测试,合子对通过口呼吸的非典型吞咽有间接影响,而口腔呼吸通过非典型吞咽对AOB有积极的间接影响。
    结论:本研究确定了不同因素与AOB存在之间的关系。这项研究的结果详细证明了AOB与接合性之间的关系,非典型吞咽,嘴巴呼吸,母乳喂养和奶瓶喂养。不进食对AOB的频率有降低的作用。在营养形式中,母乳喂养通过使口面部肌肉工作来确保口颌系统的正常发育。
    OBJECTIVE: This study aimed to assess the different pathways between predictor factors such as zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding related to anterior open bite (AOB) in twins.
    METHODS: The study was conducted in monozygotic (MZ) and dizygotic (DZ) twin children aged 3-15 years. AOB, atypical swallowing, mouth breathing, feeding type, duration of bottle use, and mouth opening status during sleep were recorded during oral examination. Partial least squares structural equation model (PLS-SEM) and sobel tests were performed to assess the total and indirect effects among the variables on AOB.
    RESULTS: A total of 404 children (29.2% MZ;70.8% DZ) participated in this study. The effect of zygosity on mouth breathing in the PLS-SEM model was statistically significant. Conversely, it was determined that mouth breathing effected that atypical swallowing (p = 0.001). Atypical swallowing triggered AOB (p = 0.001). The atypical swallowing has a mediation effect between AOB and mouth breathing (p = 0.020). Mouth breathing causes atypical swallowing and therefore indirectly increases the likelihood of AOB. While breastfeeding decreases AOB incidence (p = 0.023), bottle feeding increases AOB incidence (p = 0.046). The sobel tests show that the fully mediator variable feature of mouth breathing is statistically significant in the negative relation between zygosity and atypical swallowing.
    CONCLUSIONS: The PLS-SEM model showed that mouth breathing triggers atypical swallowing and atypical swallowing triggers AOB. As a result of this chain of relationships, an indirect effect of zygosity on AOB was observed. According to sobel tests, zygosity has an indirect effect on atypical swallowing through mouth breathing, while mouth breathing has a positive indirect effect on AOB through atypical swallowing.
    CONCLUSIONS: This study identified the relationships between different factors and the presence of AOB. The findings of this study demonstrate in detail the relationships between AOB and zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding. Brestfeeding has a reducing effect on the frequency of AOB. Among the nutritional forms, breastfeeding ensures the proper development of the stomatognathic system by working the oro-facial muscles.
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  • 文章类型: Journal Article
    单卵(MZ)双胞胎通常被认为具有相同的基因组,但最近的研究表明,早期的合子后事件可导致MZ双胞胎之间不同的DNA变异谱.这些变异可以解释表型的不一致,并有助于疾病的病因。在这里,我们对17对MZ双胞胎进行了全基因组测序,这些双胞胎不一致的精神病(精神分裂症,分裂情感障碍或双相情感障碍)。我们检查了一对双胞胎中不一致的各种稀有变体。我们确定了四个罕见的基因,预测的有害错义变异对队列中受影响的个体是私人的。从最近的精神分裂症和双相外显子组测序研究中,FOXN1和FLOT2的变体将被归类为破坏性的。此外,我们确定了四个罕见的基因拷贝数变异(CNV)私有于受影响的样本,其中两个重叠的基因已显示与精神分裂症或双相情感障碍相关的证据。一种这样的CNV是以前与自闭症和发育迟缓有关的3q29重复。迄今为止,我们对不一致的精神病表型进行了最大的MZ双胞胎研究。这些发现值得使用其他分析方法进行进一步调查。
    Monozygotic (MZ) twins are often thought to have identical genomes, but recent work has shown that early post-zygotic events can result in a spectrum of DNA variants that are different between MZ twins. Such variants may explain phenotypic discordance and contribute to disease etiology. Here we performed whole genome sequencing in 17 pairs of MZ twins discordant for a psychotic disorder (schizophrenia, schizoaffective disorder or bipolar disorder). We examined various classes of rare variants that are discordant within a twin pair. We identified four genes harboring rare, predicted deleterious missense variants that were private to an affected individual in the cohort. Variants in FOXN1 and FLOT2 would have been categorized as damaging from recent schizophrenia and bipolar exome sequencing studies. Additionally, we identified four rare genic copy number variants (CNVs) private to an affected sample, two of which overlapped genes that have shown evidence for association with schizophrenia or bipolar disorder. One such CNV was a 3q29 duplication previously implicated in autism and developmental delay. We have performed the largest MZ twin study for discordant psychotic phenotypes to date. These findings warrant further investigation using other analytical approaches.
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  • 文章类型: Journal Article
    背景:疾病不和谐的双胞胎是匹配病例对照研究的优秀受试者,因为它们可以控制混杂因素,如年龄,性别,遗传背景,宫内和早期环境因素。研究设计:横断面研究。
    方法:对所有参与者进行既往病史记录和体格检查。采取空腹静脉血样本以测量空腹血糖(FBG)和血脂水平。ACE模型,结构方程模型,用于评估遗传力。
    结果:这项研究包括710对双胞胎(210个单卵和500个双卵),年龄在2至52岁之间(平均年龄:11.67±10.71岁)。这项研究是使用2017年伊斯法罕双胞胎登记处(ITR)的参与者进行的。结果显示,在儿童早期(2-6岁),高度,体重,和体重指数(BMI)受共同环境因素的影响(76%,75%,73%,分别)。在儿童晚期(7-12岁),臀围,腰围(WC),和低密度脂蛋白(LDL)胆固醇被发现是高度可遗传的(90%,76%,64%,分别)。在青少年中,身高(94%),颈围(85%),LDL-胆固醇(81%),WC(70%),甘油三酯(69%),体重(68%),BMI(65%)均为高度或中度遗传。在成年双胞胎中,臂围(97%),体重(86%),BMI(82%),颈围(81%)具有高度遗传性。
    结论:这项研究表明,遗传和环境因素都在影响个体生命不同阶段的过程中发挥作用。值得注意的是,虽然某些特征如肥胖在童年时期具有很高的遗传力,随着个体过渡到成年,它们的遗传力趋于下降。
    BACKGROUND: Disease-discordant twins are excellent subjects for matched case-control studies as they allow for the control of confounding factors such as age, gender, genetic background, and intrauterine and early environment factors. Study design: A cross-sectional study.
    METHODS: Past medical history documentation and physical examination were conducted for all participants. Fasting venous blood samples were taken to measure fasting blood glucose (FBG) and lipid levels. The ACE model, a structural equation model, was used to assess heritability.
    RESULTS: This study included 710 twin pairs (210 monozygotic and 500 dizygotic) ranging in age from 2 to 52 years (mean age: 11.67±10.71 years). The study was conducted using participants from the Isfahan Twin Registry (ITR) in 2017. Results showed that in early childhood (2-6 years), height, weight, and body mass index (BMI) were influenced by shared environmental factors (76%, 75%, and 73%, respectively). In late childhood (7-12 years), hip circumference, waist circumference (WC), and low-density lipoprotein (LDL) cholesterol were found to be highly heritable (90%, 76%, and 64%, respectively). In adolescents, height (94%), neck circumference (85%), LDL-cholesterol (81%), WC (70%), triglycerides (69%), weight (68%), and BMI (65%) were all found to be highly or moderately heritable. In adult twins, arm circumference (97%), weight (86%), BMI (82%), and neck circumference (81%) were highly heritable.
    CONCLUSIONS: This study demonstrates that both genetic and environmental factors play a role in influencing individuals at different stages of their lives. Notably, while certain traits such as obesity have a high heritability during childhood, their heritability tends to decrease as individuals transition into adulthood.
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  • 文章类型: Case Reports
    背景技术双胎妊娠的产科并发症之一是一个胎儿的宫内死亡。在妊娠早期发生的死亡通常导致比妊娠中期和晚期死亡更少的并发症。在第二和第三个三个月,据报道,双胎妊娠的单胎死亡增加了死亡,早产,和幸存的双胞胎的神经损伤。虽然罕见,它也可能引发母亲的凝血缺陷。单绒毛膜双胞胎的神经系统疾病也比双绒毛妊娠更常见。因此,终止妊娠的考虑可能会持续存在.病例报告我们介绍了一例单绒毛膜双胎妊娠的初产妇,其胎儿在妊娠20-21周时宫内死亡。我们在12周以上的密切监测下继续妊娠,直到她在足月分娩了存活的患者。幸存的婴儿的结果是正常情况和适当的体重,没有胎儿发病,并且没有与母亲凝血障碍相关的母亲发病率。结论单绒毛膜双胎妊娠合并单胎死亡的保守治疗可能是获得良好结局的最佳选择。我们建议保守管理,在32周后使用非压力测试进行密切监测,双周超声,和至少一个母体凝血谱测试。
    BACKGROUND One of the obstetric complications of twin pregnancy was the intrauterine death of one fetus. The death that occurs in the first trimester usually leads to fewer complications than the death in the second and third trimester. In the second and third trimesters, single fetal death of twin pregnancy was reported to increase the death, preterm birth, and neurological injury of the surviving co-twin. Although rare, it might trigger a coagulation defect in the mother as well. Neurological morbidities were also more common in monochorionic twins than in dichorionic gestation. Thus, a consideration of pregnancy termination might persist. CASE REPORT We present a case of a primigravida with a monochorionic twin pregnancy whose intrauterine death of one fetus at 20-21 weeks of gestation. We managed this patient with pregnancy continuation under close monitoring more than 12 weeks until she delivered the surviving one at term. The outcome of the surviving baby was normal condition and appropriate weight, no fetal morbidity, and no maternal morbidity related to coagulation disorder in the mother. CONCLUSIONS Conservative management under close monitoring until term in monochorionic twin pregnancy with single fetal death could be the best option to obtain a favorable outcome. We recommend conservative management with close surveillance monitoring using non-stress tests after 32 weeks, biweekly ultrasound, and at least of one maternal coagulation profile test.
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  • 文章类型: Journal Article
    人类皮质下在认知中起着关键作用,并广泛涉及许多精神疾病的病理生理学。然而,基于皮质下-皮质功能连接的功能梯度的遗传力仍然难以捉摸。这里,利用来自人类连接体项目(n=1023)和青少年大脑认知发育研究(n=936)数据集的双功能MRI(fMRI)数据,我们构建了大规模的皮质下功能梯度,并描绘了从单峰感觉/运动网络到跨模态关联网络的增加的主要功能梯度模式.我们观察到这个主要的功能梯度是可遗传的,对于年轻人和儿童,遗传力的强度沿皮层下的分层单峰-跨模态轴表现出异质模式。此外,采用机器学习框架,我们表明,皮质下主要功能梯度的这种异质性模式可以准确地辨别单卵双胞胎对和二卵双胞胎对之间的关系,准确率为76.2%(P<0.001)。功能梯度的遗传度与皮质下MRI衍生的T1加权/T2加权(T1w/T2w)比率映射所产生的解剖学髓鞘有关。这项研究通过揭示皮质下功能梯度的结构和遗传特性,为皮质下功能层次的生物学基础提供了新的见解。
    The human subcortex plays a pivotal role in cognition and is widely implicated in the pathophysiology of many psychiatric disorders. However, the heritability of functional gradients based on subcortico-cortical functional connectivity remains elusive. Here, leveraging twin functional MRI (fMRI) data from both the Human Connectome Project (n = 1023) and the Adolescent Brain Cognitive Development study (n = 936) datasets, we construct large-scale subcortical functional gradients and delineate an increased principal functional gradient pattern from unimodal sensory/motor networks to transmodal association networks. We observed that this principal functional gradient is heritable, and the strength of heritability exhibits a heterogeneous pattern along a hierarchical unimodal-transmodal axis in subcortex for both young adults and children. Furthermore, employing a machine learning framework, we show that this heterogeneous pattern of the principal functional gradient in subcortex can accurately discern the relationship between monozygotic twin pairs and dizygotic twin pairs with an accuracy of 76.2% (P < 0.001). The heritability of functional gradients is associated with the anatomical myelin proxied by MRI-derived T1-weighted/T2-weighted (T1w/T2w) ratio mapping in subcortex. This study provides new insights into the biological basis of subcortical functional hierarchy by revealing the structural and genetic properties of the subcortical functional gradients.
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  • 文章类型: Journal Article
    社会科学研究认为,个人文学和文化品味的差异源于社会环境。然而,这些差异可能部分与个体之间的遗传差异有关。为了解决这种可能性,我们使用丹麦双胞胎(N=67,900)中图书馆借阅的国家规模注册数据来评估文学品味的遗传力。我们通过借用不同类型的书籍来衡量文学品味(例如,犯罪和传记小说)和格式(物理,数字,和音频),并将文学品味的总方差分解为可归因于共享基因的成分(遗传力),共享环境(兄弟姐妹共享的社会环境),和独特的环境(兄弟姐妹不共享的社会环境)。我们发现遗传差异占文学品味总变异的45-70%,共享环境几乎不占任何差异,和独特的环境占适度的份额。这些结果表明,文学品味与其他人类表型大致一样可遗传(例如,身体特征,认知,和健康)。此外,社会经济弱势群体的遗传力高于弱势群体。总的来说,我们的研究结果表明,研究应该考虑遗传差异在解释文学和更广泛的文化品味中的个体差异方面的作用。
    Social science research argues that differences in individuals\' literary and cultural tastes originate in social environments. Yet, it might be that these differences are partly associated with genetic differences between individuals. To address this possibility, we use nation-scale registry data on library borrowing among Danish twins (N = 67,900) to assess the heritability of literary tastes. We measure literary tastes via borrowing of books of different genres (e.g., crime and biographical novels) and formats (physical, digital, and audio) and decompose the total variance in literary tastes into components attributable to shared genes (heritability), shared environments (social environment shared by siblings), and unique environments (social environments not shared by siblings). We find that genetic differences account for 45-70 percent of the total variance in literary tastes, shared environments account for almost none of the variance, and unique environments account for a moderate share. These results suggest that literary tastes are approximately as heritable as other human phenotypes (e.g., physical traits, cognition, and health). Moreover, heritability is higher for socioeconomically disadvantaged groups than for advantaged groups. Overall, our results suggest that research should consider the role of genetic differences in accounting for individual differences in literary and broader cultural tastes.
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  • 文章类型: Case Reports
    LMNA中的致病变体与广泛的肌肉疾病有关:层蛋白病。LMNA相关的先天性肌营养不良是一种以早期症状为特征的层肌病,通常在年轻时导致致命的结果。儿童面临恶性心律失常的风险增加。没有建立的儿科方案来管理这种情况。我们回顾了已发表的病例,并提供了两个患有LMNA相关肌营养不良的双胞胎姐妹的疾病进展的见解。我们的目标是提出专门为儿科患者量身定制的心脏监测和管理计划。我们介绍了一个有五个成员的家庭,包括两个患有LMNA相关肌营养不良的双胞胎姐妹。对所有家庭成员进行了全面的神经肌肉和心脏检查。使用大规模测序技术对两个双胞胎进行了遗传分析。临床评估显示,只有双胞胎诊断出LMNA相关的肌营养不良。随访显示早期出现症状和危及生命的心律失常,尽管两个双胞胎都去世了,但疾病进展不同。遗传分析确定了LMNA基因中的从头罕见的错义有害变体。在与肌无力综合征相关的基因中发现了其他其他罕见变异。早发性神经肌肉症状可能与LMNA相关肌营养不良中危及生命的心律失常的预后有关。作为其他罕见变体的载体可能是表型进展的修饰因素,虽然还需要进一步的研究。迫切需要针对儿科人群的特定心脏建议,以减轻恶性心律失常的风险。
    Pathogenic variants in LMNA have been associated with a wide spectrum of muscular conditions: the laminopathies. LMNA-related congenital muscular dystrophy is a laminopathy characterised by the early onset of symptoms and often leads to a fatal outcome at young ages. Children face a heightened risk of malignant arrhythmias. No established paediatric protocols for managing this condition are available. We review published cases and provide insights into disease progression in two twin sisters with LMNA-related muscular dystrophy. Our objective is to propose a cardiac surveillance and management plan tailored specifically for paediatric patients. We present a family of five members, including two twin sisters with LMNA-related muscular dystrophy. A comprehensive neuromuscular and cardiac work-up was performed in all family members. Genetic analysis using massive sequencing technology was performed in both twins. Clinical assessment showed that only the twins showed diagnoses of LMNA-related muscular dystrophy. Follow-up showed an early onset of symptoms and life-threatening arrhythmias, with differing disease progressions despite both twins passing away. Genetic analysis identified a de novo rare missense deleterious variant in the LMNA gene. Other additional rare variants were identified in genes associated with myasthenic syndrome. Early-onset neuromuscular symptoms could be related to a prognosis of worse life-threatening arrhythmias in LMNA related muscular dystrophy. Being a carrier of other rare variants may be a modifying factor in the progression of the phenotype, although further studies are needed. There is a pressing need for specific cardiac recommendations tailored to the paediatric population to mitigate the risk of malignant arrhythmias.
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  • 文章类型: Journal Article
    对于人类来说,语言是一种进化上突出的能力,它依赖于跨越额叶的分布式大脑网络,temporal,顶叶,和皮质下区域。为了了解复杂的语言网络是否具有共同或不同的遗传机制,我们研究了大脑对语言反应的遗传效应与一组被建议与语言共同进化的对象域之间的关系:工具,面孔(表示社交),和身体部位(表示社交和手势)。分析HumanConnectomeProject(HCP)发布的双胞胎数据集,该数据集具有来自经历语言和工作记忆任务的人类双胞胎受试者(单卵和双卵)的fMRI数据,这些数据集具有多个对象域(语言任务为198名女性和144名男性;工作记忆任务为192名女性和142名男性),我们确定了额叶和颞叶皮质中的一组皮质区域以及皮质下区域,其语言活动受到遗传影响很大。人类基因表达谱(AHBA数据集)的显着差异证实了这些语言簇之间遗传效应的异质性。其中,双侧基底神经节(主要是背尾状)表现出共同的语言遗传基础,工具,和身体部位加工,右颞上回在多种类型的分析中表现出语言和工具处理的共同遗传基础。这些结果揭示了语言神经过程的异质性遗传模式,揭示语言的进化及其与工具和身体功能的共同起源。重要性声明人类语言需要一个跨越额叶的分布式大脑网络,temporal,顶叶,和皮质下区域。为了阐明这个复杂的语言网络的遗传基础,我们采用了HCPfMRI孪生数据,以检查大脑对语言和假设与语言共同进化的对象域的遗传效应之间的关系(工具,社会,和身体动作)。双侧基底神经节表现出语言的共同遗传基础,工具,和身体部位加工,以及语言和工具处理的正确上颞回。这些结果为语言神经过程的异质性遗传模式提供了证据,并揭示了其与工具和身体行为的潜在起源。
    Language is an evolutionarily salient faculty for humans that relies on a distributed brain network spanning across frontal, temporal, parietal, and subcortical regions. To understand whether the complex language network shares common or distinct genetic mechanisms, we examined the relationships between the genetic effects underlying the brain responses to language and a set of object domains that have been suggested to coevolve with language: tools, faces (indicating social), and body parts (indicating social and gesturing). Analyzing the twin datasets released by the Human Connectome Project that had functional magnetic resonance imaging data from human twin subjects (monozygotic and dizygotic) undergoing language and working memory tasks contrasting multiple object domains (198 females and 144 males for the language task; 192 females and 142 males for the working memory task), we identified a set of cortical regions in the frontal and temporal cortices and subcortical regions whose activity to language was significantly genetically influenced. The heterogeneity of the genetic effects among these language clusters was corroborated by significant differences of the human gene expression profiles (Allen Human Brain Atlas dataset). Among them, the bilateral basal ganglia (mainly dorsal caudate) exhibited a common genetic basis for language, tool, and body part processing, and the right superior temporal gyrus exhibited a common genetic basis for language and tool processing across multiple types of analyses. These results uncovered the heterogeneous genetic patterns of language neural processes, shedding light on the evolution of language and its shared origins with tools and bodily functions.
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  • 文章类型: Journal Article
    人脐带(hUC)是连接胎儿与母亲的生命线。hUC的高螺旋与产前和围产期发病率和死亡率有关。我们使用最先进的成像和组学方法研究了hUC超卷的起源。对hUC的宏观检查显示,螺旋起源于动脉,而不是hUC的其他成分。hUC动脉的数字重建显示,中膜中两层肌纤维的动态排列方向相反。我们观察到基因同卵双胞胎可能对hUC盘绕不一致,排除遗传,许多环境,和hUC卷绕的父母起源。比较四对双生子的hUC动脉的转录组和DNA甲基化谱,我们检测到28个差异表达基因,但没有差异甲基化的CpG.这些基因在血管发育中起作用,细胞-细胞相互作用,和轴的形成,并可能导致hUC螺旋数量的增加。当组合时,我们的研究结果为理解胎儿发育中hUC螺旋的起源提供了一个新的框架.
    The human umbilical cord (hUC) is the lifeline that connects the fetus to the mother. Hypercoiling of the hUC is associated with pre- and perinatal morbidity and mortality. We investigated the origin of hUC hypercoiling using state-of-the-art imaging and omics approaches. Macroscopic inspection of the hUC revealed the helices to originate from the arteries rather than other components of the hUC. Digital reconstruction of the hUC arteries showed the dynamic alignment of two layers of muscle fibers in the tunica media aligning in opposing directions. We observed that genetically identical twins can be discordant for hUC coiling, excluding genetic, many environmental, and parental origins of hUC coiling. Comparing the transcriptomic and DNA methylation profile of the hUC arteries of four twin pairs with discordant cord coiling, we detected 28 differentially expressed genes, but no differentially methylated CpGs. These genes play a role in vascular development, cell-cell interaction, and axis formation and may account for the increased number of hUC helices. When combined, our results provide a novel framework to understand the origin of hUC helices in fetal development.
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  • 文章类型: Journal Article
    背景:我们的目的是使用羊水醛固酮(AF-ALD)水平研究单绒毛膜双胞胎中胎盘吻合术的存在与肾素-血管紧张素-醛固酮激活的双胞胎间差异之间的关系。此外,本研究还研究了单绒毛膜双胞胎中AF-ALD与脐带血ALD水平(UCB-ALD)之间的关系.
    方法:这项前瞻性研究包括单绒毛膜双胎(MD)双胎妊娠,分娩时没有双胎对双胎输血综合征(TTTS)。分娩时从每对双胞胎中收集羊水和脐静脉血样,随后测量ALD水平。MD双胞胎分为两组:胎盘吻合的双胞胎和由于胎儿镜激光手术而没有吻合的双胞胎。分析了较大和较小双胞胎之间AF-ALD水平的差异。
    结果:在131例MD双胞胎中,AF-ALD水平与UCB-ALD水平呈强且显着的正相关(r=0.804,p<0.001)。在41和28对有和没有胎盘吻合的MD双胞胎中检查了双胞胎之间的差异,分别。在有胎盘吻合术的MD双胞胎中,小双胞胎的AF-ALD水平明显高于大双胞胎(p=0.003);然而,无胎盘吻合的双生子间差异无统计学意义(p>0.05)。
    结论:AF-ALD水平反映了MD双胞胎的UCB-ALD水平。胎盘吻合的存在导致MD双胞胎中ALD水平的双胞胎间不一致,即使TTTS并不复杂。人们认为单绒毛膜双胞胎有这种临床背景,它导致了TTTS的发展。
    BACKGROUND: Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin-angiotensin-aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF-ALD) levels. In addition, this study also examined the association between AF-ALD and the ALD levels in the umbilical cord blood (UCB-ALD) in monochorionic twins.
    METHODS: This prospective study included monochorionic diamniotic (MD) twin pregnancies that were not complicated by twin-to-twin transfusion syndrome (TTTS) at delivery. Amniotic fluid and umbilical cord vein blood samples were collected from each twin at delivery, and the ALD levels were measured subsequently. The MD twins were divided into two groups: those with placental anastomoses and those without anastomoses owing to fetoscopic laser surgery. The differences in the AF-ALD levels between the larger and smaller twins were analyzed.
    RESULTS: The AF-ALD levels showed a strong and significant positive correlation with UCB-ALD levels in 131 MD twins (r = 0.804, p < 0.001). Intertwin differences were examined in 41 and 28 pairs of MD twins with and without placental anastomoses, respectively. The AF-ALD levels in the smaller twins were significantly higher than those in the larger twins among the pairs of MD twins with placental anastomoses (p = 0.003); however, no statistically significant intertwin differences were observed among the twins without placental anastomoses (p > 0.05).
    CONCLUSIONS: The AF-ALD levels reflect the UCB-ALD levels in MD twins. The presence of placental anastomoses led to intertwin discordance in the ALD levels in MD twins even uncomplicated with TTTS. It was considered that monochorionic twins have this clinical background, and it leads to the development of TTTS.
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