早产与足月小于胎龄儿第1年体格生长差异的队列研究  

Cohort study of physical growth differences between preterm and full-term small for gestational age infants in the first year

作　　者：杨琴[1] 张萱[1] 程茜[1] 

机构地区：[1]重庆医科大学附属儿童医院儿童保健科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《第三军医大学学报》2016年第14期1664-1668,共5页Journal of Third Military Medical University

基　　金：重庆市卫生局科研计划面上项目(20132054)~~

摘　　要：目的探讨早产小于胎龄儿（small for gestational age,SGA）在生后1年内的体格生长变化趋势是否与足月SGA存在差异,为早产SGA生后体格生长随访监测提供参考依据。方法采用前瞻性队列研究,收集2013年9月至2015年6月在重庆医科大学附属儿童医院儿童保健科随访的早产SGA 54人,足月SGA 181人。分别在1、3、6、12月龄（早产SGA在纠正胎龄的1、3、6、12月龄）测量体质量、身长、头围,采用Z积分计算体格水平和生长速度。结果 ①早产SGA生后快速追赶生长发生在纠正年龄1月龄后,而足月SGA在生后即开始;早产和足月SGA在前6个月追赶生长率均达63.0%。②早产SGA未纠正胎龄的体质量Z值在6、12月龄（t=-1.189、-0.911,P=0.236、0.363）,身长、头围Z值在12月龄（t=-0.855、-1.078,P=0.394、0.282）与足月SGA比较差异无统计学意义。③早产SGA的体质量增长速度在1-3、〉3-6月龄（t=4.685、3.787,P〈0.01）,身长、头围在1-3、〉3-6、〉6-12月龄追赶速度明显快于足月SGA（t=3.487、3.626、4.179,t=5.158、3.001、4.641,P〈0.01）。但在1月龄内体质量、身长追赶速度均慢于足月SGA（t=-6.384、-4.821,P〈0.01）,甚至低于出生时Z值水平（ΔZ〈0）。结论早产SGA追赶生长的发生晚于足月SGA,体格生长水平可在1岁时追赶上足月SGA,在1岁内生长潜力大于足月SGA,在纠正年龄1月龄内易发生宫外生长迟缓。Objective To explore the differences of physical growth trends between preterm and full- term small for gestational age （SGA） infants in the first year. Methods Prospective cohort study was adopted to collect 54 preterm SGA infants and 181 full-term SGA infants, who were followed-up at health care department of children＇ s hospital of Chongqing medical university from September 2013 to June 2015. The weight, length, head circumference and growth rate were measured by using Z scores at the ages of 1 month, 3 months, 6 months and 12 months, and the preterm SGA infants were measured at the corrected gestational ages of 1 month, 3 months, 6 months and 12 months. Results Preterm SGA began rapid catch-up growth after corrected age of 1 month, while full-term SGA began after birth. The catch-up growth rates of preterm and full-term SGA reached to 63 % in the first 6 months. There were no significant differences in the weight Z score at the not-corrected gestational age of 6 months and 12 months （t = - 1. 189, - 0. 911, P = 0. 236,0. 363 ）, length （t = - 0. 855, P = 0. 394） and head circumference Z score in 12 months （t = - 1. 078, P = 0. 282） between the preterm SGA infants and full-term SGA infants. The chasing speed of weight （ t = 4. 685, 3. 787, P 〈 0.01 ） of preterm SGA was obviously faster than that of full-term SGA during 1 - 3 months and 〉3-6 months, and the chasing speeds of length （t =3.487, 3. 626, 4. 179, P 〈0. 01） and head circumference （t = 5. 158, 3. 001,4. 641, P 〈 0.01 ） in preterm SGA were obviously faster than those of full- term SGA during 1 -3 months, 〉3-6 months and 〉6 - 12 months. But the chasing speeds of weight and length of preterm SGA were obviously slower than those of full-term SGA within 1 month （ t = - 6. 384, -4. 821, P 〈 0. 01 ）, even below the Z score at birth （ AZ 〈 0）. Conclusion The starting point of catch-up growth of preterm SGA is latter than that of full-term SGA. The physical growth levels of preterm SGA can catch up with ful

关 键 词：婴儿 小于胎龄 婴儿 早产 足月分娩 身体测量 

分 类 号：R179[医药卫生—妇幼卫生保健] R181.37[医药卫生—公共卫生与预防医学]