双胞胎尿道下裂与低出生体重的相关性分析  

Correlation analysis of low birth weight and hypospadias in twins

作　　者：林德富[1] 黄洋阅 孙宁[1] 张潍平[1] 宋宏程[1] Lin Defu;Huang Yangyue;Sun Ning;Zhang Weiping;Song Hongcheng(Department of Urology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《临床小儿外科杂志》2022年第1期7-12,共6页Journal of Clinical Pediatric Surgery

基　　金：中国国家重点研发计划(2016YFC1000807);北京市医院管理局儿科学科协同发展中心儿科专项(XTYB201823)。

摘　　要：目的初步探讨双胞胎尿道下裂与低出生体重的关系。方法回顾性分析2013年1月至2020年1月首都医科大学附属北京儿童医院泌尿外科收治的42对双胞胎尿道下裂患儿临床资料,记录双胞胎出生体重。根据尿道开口位置,将尿道下裂分为4型:Ⅰ型为阴茎头和冠状沟型,Ⅱ型为阴茎体型,Ⅲ型为阴茎阴囊型,Ⅳ型为会阴型。应用全外显子测序技术和生物信息学分析技术检测所有双胞胎的全血标本,证实同卵双胞胎23对、异卵双胞胎19对。记录母孕期黄体酮应用情况、怀孕年龄、妊娠期高血压、吸烟史、饮酒史等资料。结果42对双胞胎中共有尿道下裂54例,其中I型6例,Ⅱ型20例,Ⅲ型22例,Ⅳ型6例。相对于异卵双胞胎而言,同卵双胞胎更易同时患尿道下裂(OR=6.500,95%CI:1.217~35.124)。双胞胎尿道下裂与出生体重的相关性分析显示,低出生体重是尿道下裂的危险因素(OR=4.124,95%CI:1.588~10.710,P=0.004)。与正常出生体重儿相比,低出生体重儿患尿道下裂的风险是正常出生体重儿的5.885倍(OR=5.885,95%CI:1.082~32.014,P=0.040);极低出生体重儿患尿道下裂的风险是正常出生体重儿的3.804倍(OR=3.804,95%CI:1.406~10.293,P=0.009)。在只有其一患尿道下裂的13对同卵双生双胞胎中,患尿道下裂和未患尿道下裂者出生体重分别为(1805±437)g和(2598±582)g,差异有统计学意义(t=3.929,P=0.001);低出生体重(OR=25.955,95%CI:2.069~325.556,P=0.012)是发生尿道下裂的危险因素。双胞胎中只有其一患尿道下裂的17对异卵双生双胞胎中,患尿道下裂和未患尿道下裂者出生体重分别为(2077±677)g和(2527±478)g,差异有统计学意义(t=2.242,P=0.032);低出生体重(OR=3.929,95%CI:1.041~13.837,P=0.044)是发生尿道下裂的危险因素。孕期应用黄体酮不会增加双胞胎患尿道下裂的风险(OR=1.458,95%CI:0.572~3.853,P=0.416)。结论同卵和异卵双胞胎中出生体重较低者更易患尿道下裂。Objective To expolre the relationship between birth weight and the hypospadias in twins. Methods Retrospective analysis was conducted for 42 pairs of twins with hypospadias from January 2013 to January 2020.The twins’ birth weight were recorded.According to the location of urethral opening, hypospadias can be divided into 4 types: type Ⅰ is glans penis and coronary groove hypospadias, type Ⅱ is penile hypospadias, type Ⅲ is scrotal hypospadias, and type IV is perineal hypospadias.The whole blood samples of all twins were examined by whole exon sequencing and bioinformatics analysis The examination confirmed 23 pairs of monozygotic twins and 19 pairs of dizygotic twins. Results There were 54 cases of hypospadias in 42 pairs of twins, including 6 type I hypospadias, 20 type Ⅱ hypospadias, 22 type Ⅲ hypospadias and 6 type Ⅳ hypospadias.Monozygotic twins were more likely to have hypospadias than dizygotic twins(OR=6.5,95%CI:1.217~35.124).The correlation analysis of low birth weight and hypospadias in twins showed that low birth weight was a risk factor for hypospadias(OR=4.124,95%CI:1.588~10.710,P=0.004).The risk of hypospadias in low birth weight infants was 5.885 times higher than that of normal weight infants(OR=5.885,95%CI:1.082~32.014,P=0.040),while the risk of hypospadias in extremely low birth weight infant was 3.804 times higher(OR=3.804,95%CI:1.406~10.293,P=0.009).Among the 13 pairs of discordant monozygotic twins, the birth weights of those with and without hypospadias were(1 805±437) g and(2 598±582) g respectively, and the difference was statistically significant(t=3.929,P=0.001).Low birth weight(OR=25.955,95%CI:2.069~325.556,P=0.012) was a risk factor for hypospadias in discordant monozygotic twins.For the 17 pairs of discordant dizygotic twins, the birth weights of those with and without hypospadias were(2 077±677) g and(2 527±478) g respectively with statistically significant difference(t=2.242,P=0.032).Low birth weight(OR=3.929,95%CI:1.041~13.837,P=0.044) was a risk factor for hyposp

关 键 词：尿道下裂/病因学 双胞胎 婴儿 超低出生体重 婴儿 极低出生体重 

分 类 号：R726.9[医药卫生—儿科]