早产儿追赶生长与胰岛素抵抗的相关性  

Relationship between catch-up growth of premature infants and insulin resistance

作　　者：王鉴 杨萌婷 陈晓霞[1] 黄康[1] 童雪涛[1] 陈茂琼[1] 

机构地区：[1]贵阳医学院附属医院新生儿科,550004

出　　处：《中华实用儿科临床杂志》2015年第8期593-596,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：贵州省科技厅科学技术基金[黔科合J字（2009）2160号]

摘　　要：目的 通过对早产儿进行生化代谢指标的分析,探讨追赶生长对胰岛素抵抗（IR）的影响.方法 2010年12月至2013年12月贵阳医学院附属医院新生儿科收治的早产儿共126例[排除可能影响胰岛素（INS）、C肽、胰岛素样生长因子-1（IGF-1）正常分泌的因素],根据胎龄和出生体质量,将其分为小于胎龄（SGA）组及适于胎龄（AGA）组,并根据随访时年龄分为1～6个月、7～12个月、≥1～3岁（幼儿期）3组;随访对象（出生1周内、6个月、12个月、24个月、36个月）均于清晨取空腹外周静脉血6 mL,分别检测INS、C肽、IGF-1、三酰甘油（TC）、总胆固醇（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）、清蛋白、前清蛋白、肌酐,同时测量其体格指标,包括体质量、身长,计算出胰岛素抵抗指数（IRI）、Ponderal指数、体质量标准差计分（SDS）、身长SDS.结果 1.早产儿出生后出现追赶生长占65.6％ （63/96例）,未出现追赶生长占34.4％（33/96例）,其中追赶生长良好组37例（SGA组8例,AGA组29例）,有追赶生长组26例（SGA 7例,AGA 19例）,未追赶生长组33例（SGA组11例,AGA组22例）,SGA组和AGA组间追赶生长程度总体分布差异无统计学意义（P＞0.05）.2.幼儿期追赶生长良好组IGF-1、前清蛋白较未追赶生长组高（F=3.55、4.94）,LgIRI、LgINS较未追赶生长组低（F=3.55、3.47）,差异有统计学意义（P＜0.05）;追赶生长程度越大,LgSIRI值越低,IGF-1、前清蛋白水平越高.3.LgIRI的影响因素包括SGA（OR=7.904,P=0.001）、出生体质量＜1 500 g（OR=8.737,P=0.019）、未追赶生长（OR=11.706,P=0.000）.结论 幼儿期追赶生长程度越大,IR越低,IGF-1、前清蛋白水平越高;IR的影响因素包括SGA、低出生体质量及未追赶生长,且未追赶生长影响最大.Objective To investigate the effect of catch-up growth on insulin resistance（IR） through analysis of biochemical and metabolic indices in premature infants.Methods There were 126 infants admitted in the Department of Neonatology,the Affiliated Hospital of Guiyang Medical College from December 2010 to December 2013 [factors which might affect the secretion of insulin（INS）,C peptide and insulin-like growth factor-1 （IGF-1） were excluded].According to gestational age and birth weight,babies were divided into small for gestational age （SGA） group and appropriate for gestational age （AGA） group.And according to the age on follow-up,babies were divided into 1-to-6-month-old group,7-to-12-month-old group and ≥ 1-to-3 year-old group.All cases had 6 mL peripheral venous blood sampled in the early morning during fasting in the first week,and 6,12,24,36 months after birth.They were tested for levels of INS,C peptide,IGF-1,triglyceride （TC）,total cholesterol （TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,fasting blood-glucose （FBG）,albumin,prealbumin and creatinine respectively.At the same time,the physical parameters were measured,including weight,body length,and calculated insulin resistance index （IRI）,Ponderal index,weight standard deviation score （SDS）,and length SDS.Results （1） Catch-up growth after premature birth occupied 65.6% （63/96 cases）,whereas no catch-up growth occupied 34.4% （33/96 cases） of study snbjects,and among them catch-up growth of 37 cases was better （8 cases of SGA,29 cases of AGA）,26 cases showing catch-up growth（7 cases of SGA,19 cases of AGA）,33 cases without catch-up growth（11 cases of SGA,22 cases of AGA）.No statistical significance was found in the distribution of catch-up growth between SGA group and AGA group（P 〉 0.05）.（2） The LgIRI,LgINS of group with good catch-up growth was significantly lower than the group with no catch-up growth group （F =3.55,3.47） in in

关 键 词：婴儿 早产 追赶生长 胰岛素抵抗 

分 类 号：R722.6[医药卫生—儿科]