Spekman Jip A, Israëls Joël, de Vreede Ilja, Los Mady, Geelhoed Miranda J J, van Zwet Erik W, Haak Monique C, Roest Arno A W, van Klink Jeanine M M, Lopriore Enrico, Groene Sophie G
Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands.
Pediatric Pulmonology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands.
EClinicalMedicine. 2024 Apr 10;72:102600. doi: 10.1016/j.eclinm.2024.102600. eCollection 2024 Jun.
Fetal growth restriction (FGR) can negatively affect lung development, leading to increased respiratory morbidity and reduced lung function later in life. Studies regarding the impact of FGR on lung function in singletons are influenced by genetic, obstetric, and maternal factors. To overcome these confounding factors, we aim to investigate lung function in identical twins with selective FGR (sFGR).
Lung function assessments were performed in identical twins with sFGR born in our centre between March 1, 2002, and December 31, 2017, aged between 5 and 17 years. sFGR was defined as birthweight discordance ≥20%. Outcome measures consisted of forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), and transfer factor for carbon monoxide (DLCO) and were compared between the smaller and larger twin.
Thirty-nine twin pairs performed spirometry of sufficient quality. Median gestational age at birth was 34.3 (interquartile range (IQR) 32.1-36.0) weeks with median birthweights of 1500 (IQR 1160-1880) grams and 2178 (IQR 1675-2720) grams for the smaller and larger twin, respectively. Smaller twins had significantly lower z-scores for FEV (-0.94 versus -0.41, = 0.0015), FVC (-0.56 versus -0.06, < 0.0001) and DLCO (-0.50 versus 0.00, < 0.0001) compared to larger co-twins.
Although being genetically identical, sFGR in identical twins is associated with a reduction in static and dynamic lung volume and a reduction in lung diffusion, even when taking the reduced lung volume into account. This indicates that adverse growth conditions in utero negatively affect lung development and function, potentially contributing to an increase in respiratory morbidities later in life.
The Dutch Heart Foundation and The Bontius Foundation.
胎儿生长受限（FGR）会对肺发育产生负面影响，导致日后呼吸系统发病率增加和肺功能下降。关于FGR对单胎肺功能影响的研究受到遗传、产科和母体因素的影响。为克服这些混杂因素，我们旨在研究选择性胎儿生长受限（sFGR）的同卵双胞胎的肺功能。
对2002年3月1日至2017年12月31日在我们中心出生的年龄在5至17岁的患有sFGR的同卵双胞胎进行肺功能评估。sFGR定义为出生体重差异≥20%。观察指标包括1秒用力呼气量（FEV）、用力肺活量（FVC）和一氧化碳弥散量（DLCO），并在较小和较大的双胞胎之间进行比较。
39对双胞胎进行了质量足够的肺活量测定。出生时的中位孕周为34.3（四分位间距（IQR）32.1 - 36.0）周，较小和较大双胞胎的中位出生体重分别为1500（IQR 1160 - 1880）克和2178（IQR 1675 - 2720）克。与较大的双胞胎相比，较小的双胞胎在FEV（-0.94对-0.41，P = 0.0015）、FVC（-0.56对-0.06，P < 0.0001）和DLCO（-0.50对0.00，P < 0.0001）方面的z评分显著更低。
尽管同卵双胞胎基因相同，但即使考虑到肺容积减小，sFGR仍与静态和动态肺容积减少以及肺扩散降低有关。这表明子宫内不良生长条件会对肺发育和功能产生负面影响，可能导致日后呼吸系统发病率增加。
荷兰心脏基金会和邦提乌斯基金会。
