Gardiner H M, Barlas A, Matsui H, Diemert A, Taylor M J O, Preece J, Gordon F, Greenwald S E, Hecher K
1Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK.
3Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK.
J Dev Orig Health Dis. 2012 Jun;3(3):182-9. doi: 10.1017/S204017441200013X.
We assessed vascular programming in genetically identical monochorionic twin pairs with twin-to-twin transfusion syndrome (TTTS) treated differently in utero by serial amnioreduction or fetal laser arterial photocoagulation. This case-control study re-assessed four twin groups at median 11 years comprising 20 pairs of monochorionic diamniotic twins: nine treated by amnioreduction (TTTS-amnio) and eleven by laser (TTTS-laser) with seven monochorionic and six dichorionic control pairs. Outcome measures were current blood pressure (BP), brachio-radial arterial stiffness derived from pulse wave velocity (PWV), resting microcirculation (Flux) and response to heating and post-occlusive reactive hyperaemia measured using laser Doppler. Potential confounders [PWV and BP at first study, current height, weight, heart rate and twin type (ex-recipient, ex-donor or heavier/lighter of pair)] were accounted for by Mixed Linear Models statistical methodology. PWV dichorionic > monochorionic (P = 0.024); systolic and diastolic BP dichorionic > TTTS-amnio and TTTS-laser (P = 0.004, P = 0.02 and P = 0.005, P = 0.02, respectively). Within-twin pair pattern of PWV discordance was similar in laser treated and dichorionic controls (heavier-born > lighter), opposite to TTTS-amnio and monochorionic controls. Flux monochorionic > dichorionic (P = 0.044) and heavier > lighter-born (P = 0.024). TTTS-laser and dichorionic diamniotic showed greatest hyperaemic responses (dichorionic > TTTS-amnio or monochorionic controls (P = 0.007, P = 0.025). Hyperaemic responses were slower in heavier-born twins (P = 0.005). In summary, monochorionic twins had lower BP, arterial stiffness and increased resting vasodilatation than dichorionic twins implying shared fetal circulation affects vascular development. Vascular responses in laser-TTTS were similar to dichorionic and opposite to TTTS-amnio suggesting a lasting effect of fetal therapy on vascular health.
我们评估了患有双胎输血综合征（TTTS）的同基因单绒毛膜双胎对的血管编程情况，这些双胎对在子宫内接受了不同的治疗，即连续羊水减量术或胎儿激光动脉光凝术。这项病例对照研究在中位数11岁时重新评估了四个双胎组，包括20对单绒毛膜双羊膜囊双胎：9对接受羊水减量术治疗（TTTS - amnio），11对接受激光治疗（TTTS - laser），另有7对单绒毛膜和6对双绒毛膜对照双胎对。观察指标包括当前血压（BP）、由脉搏波速度（PWV）得出的肱桡动脉僵硬度、静息微循环（通量）以及使用激光多普勒测量的对加热和闭塞后反应性充血的反应。潜在混杂因素[首次研究时的PWV和BP、当前身高、体重、心率以及双胎类型（前受血儿、前供血儿或双胎对中较重/较轻者）]通过混合线性模型统计方法进行分析。双绒毛膜双胎的PWV > 单绒毛膜双胎（P = 0.024）；双绒毛膜双胎的收缩压和舒张压 > TTTS - amnio组和TTTS - laser组（分别为P = 0.004、P = 0.02和P = 0.005、P = 0.02）。激光治疗组和双绒毛膜对照双胎对中，双胎对内PWV不一致的模式相似（出生体重较重者 > 出生体重较轻者），与TTTS - amnio组和单绒毛膜对照双胎对相反。通量方面，单绒毛膜双胎 > 双绒毛膜双胎（P = 0.044），且出生体重较重者 > 出生体重较轻者（P = 0.024）。TTTS - laser组和双绒毛膜双羊膜囊双胎显示出最大的充血反应（双绒毛膜双胎 > TTTS - amnio组或单绒毛膜对照双胎对，P = 0.007，P = 0.025）。出生体重较重的双胎充血反应较慢（P = 0.005）。总之，与双绒毛膜双胎相比，单绒毛膜双胎的血压较低、动脉僵硬度较低且静息血管舒张增加，这意味着共享的胎儿循环会影响血管发育。激光治疗的TTTS双胎的血管反应与双绒毛膜双胎相似，与TTTS - amnio组相反，提示胎儿治疗对血管健康有持久影响。
