Spiegler Juliane, Härtel Christoph, Schulz Lena, von Wurmb-Schwark Nicole, Hoehn Thomas, Kribs Angela, Küster Helmut, Siegel Jens, Wieg Christian, Weichert Jan, Herting Egbert, Göpel Wolfgang
Department of Pediatrics, University Hospital of Schleswig-Holstein, Luebeck, Germany.
Twin Res Hum Genet. 2012 Aug;15(4):532-6. doi: 10.1017/thg.2012.33.
The increasing rates of preterm birth among twins implicate that solid data on associated risks and outcomes are required. Assessment of zygosity is often based on clinical criteria (evaluation of placenta; same gender, birth weight discordance as surrogate criteria for monochorionic/monozygotic twins). The aim of this study was to compare clinical versus genetic assessment of zygosity and to compare causes of preterm delivery as well as outcome data of very-low-birth-weight (VLBW; birth weight <1,500 g) twins stratified to zygosity. In a multicenter study, we selected n=176 sets of same gender twins and determined zygosity genetically. In a subgroup of 123 sets of twins, the attending physicians at the study centers were asked to document the parameter 'zygosity' (monozygotic/dizygotic) on the basis of their clinical judgment. Concordance between genetic and clinical assessment was 62.7% for monozygotic twins and 88.9% for dizygotic twins, respectively. Outcome parameters (death, BPD, ROP, NEC, IVH) were comparable in both groups. Genetically dizygotic twins were significantly more often born due to intrauterine infection (33% vs. 20% in monozygotic twins, p<.01) and antenatal antibiotics were more frequently given to mothers of dizygotic twins (62% vs. 47% in monozygotic twins, p<.01). Obstetric complications such as twin-twin-transfusion-syndrome were only seen in monozygotic twins as expected. The unexpected increase of antenatal antibiotic treatment and birth due to intrauterine infection in dizygotic twins should be confirmed in additional VLBW twin-cohorts.
双胞胎早产率的上升意味着需要有关相关风险和结局的可靠数据。合子性评估通常基于临床标准（胎盘评估；同性别、出生体重差异作为单绒毛膜/单卵双胞胎的替代标准）。本研究的目的是比较合子性的临床评估与基因评估，并比较早产原因以及按合子性分层的极低出生体重（VLBW；出生体重<1500 g）双胞胎的结局数据。在一项多中心研究中，我们选择了n = 176对同性别双胞胎，并通过基因检测确定合子性。在123对双胞胎的亚组中，研究中心的主治医生被要求根据他们的临床判断记录“合子性”（单卵/双卵）参数。单卵双胞胎的基因评估与临床评估的一致性分别为62.7%，双卵双胞胎为88.9%。两组的结局参数（死亡、支气管肺发育不良、视网膜病变、坏死性小肠结肠炎、脑室内出血）具有可比性。基因检测为双卵的双胞胎因宫内感染出生的频率显著更高（33% 对比单卵双胞胎中的20%，p<0.01），双卵双胞胎的母亲更频繁地接受产前抗生素治疗（62% 对比单卵双胞胎中的47%，p<0.01）。如预期的那样，双胎输血综合征等产科并发症仅在单卵双胞胎中出现。双卵双胞胎产前抗生素治疗的意外增加以及因宫内感染导致的出生情况应在更多的极低出生体重双胞胎队列中得到证实。
