中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
8期
593-596
,共4页
婴儿,早产%追赶生长%胰岛素抵抗
嬰兒,早產%追趕生長%胰島素牴抗
영인,조산%추간생장%이도소저항
Preterm infant%Catch-up growth%Insulin resistance
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.
目的 通過對早產兒進行生化代謝指標的分析,探討追趕生長對胰島素牴抗(IR)的影響.方法 2010年12月至2013年12月貴暘醫學院附屬醫院新生兒科收治的早產兒共126例[排除可能影響胰島素(INS)、C肽、胰島素樣生長因子-1(IGF-1)正常分泌的因素],根據胎齡和齣生體質量,將其分為小于胎齡(SGA)組及適于胎齡(AGA)組,併根據隨訪時年齡分為1～6箇月、7～12箇月、≥1～3歲(幼兒期)3組;隨訪對象(齣生1週內、6箇月、12箇月、24箇月、36箇月)均于清晨取空腹外週靜脈血6 mL,分彆檢測INS、C肽、IGF-1、三酰甘油(TC)、總膽固醇(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、空腹血糖(FBG)、清蛋白、前清蛋白、肌酐,同時測量其體格指標,包括體質量、身長,計算齣胰島素牴抗指數(IRI)、Ponderal指數、體質量標準差計分(SDS)、身長SDS.結果 1.早產兒齣生後齣現追趕生長佔65.6％ (63/96例),未齣現追趕生長佔34.4％(33/96例),其中追趕生長良好組37例(SGA組8例,AGA組29例),有追趕生長組26例(SGA 7例,AGA 19例),未追趕生長組33例(SGA組11例,AGA組22例),SGA組和AGA組間追趕生長程度總體分佈差異無統計學意義(P＞0.05).2.幼兒期追趕生長良好組IGF-1、前清蛋白較未追趕生長組高(F=3.55、4.94),LgIRI、LgINS較未追趕生長組低(F=3.55、3.47),差異有統計學意義(P＜0.05);追趕生長程度越大,LgSIRI值越低,IGF-1、前清蛋白水平越高.3.LgIRI的影響因素包括SGA(OR=7.904,P=0.001)、齣生體質量＜1 500 g(OR=8.737,P=0.019)、未追趕生長(OR=11.706,P=0.000).結論 幼兒期追趕生長程度越大,IR越低,IGF-1、前清蛋白水平越高;IR的影響因素包括SGA、低齣生體質量及未追趕生長,且未追趕生長影響最大.
목적 통과대조산인진행생화대사지표적분석,탐토추간생장대이도소저항(IR)적영향.방법 2010년12월지2013년12월귀양의학원부속의원신생인과수치적조산인공126례[배제가능영향이도소(INS)、C태、이도소양생장인자-1(IGF-1)정상분비적인소],근거태령화출생체질량,장기분위소우태령(SGA)조급괄우태령(AGA)조,병근거수방시년령분위1～6개월、7～12개월、≥1～3세(유인기)3조;수방대상(출생1주내、6개월、12개월、24개월、36개월)균우청신취공복외주정맥혈6 mL,분별검측INS、C태、IGF-1、삼선감유(TC)、총담고순(TG)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、공복혈당(FBG)、청단백、전청단백、기항,동시측량기체격지표,포괄체질량、신장,계산출이도소저항지수(IRI)、Ponderal지수、체질량표준차계분(SDS)、신장SDS.결과 1.조산인출생후출현추간생장점65.6％ (63/96례),미출현추간생장점34.4％(33/96례),기중추간생장량호조37례(SGA조8례,AGA조29례),유추간생장조26례(SGA 7례,AGA 19례),미추간생장조33례(SGA조11례,AGA조22례),SGA조화AGA조간추간생장정도총체분포차이무통계학의의(P＞0.05).2.유인기추간생장량호조IGF-1、전청단백교미추간생장조고(F=3.55、4.94),LgIRI、LgINS교미추간생장조저(F=3.55、3.47),차이유통계학의의(P＜0.05);추간생장정도월대,LgSIRI치월저,IGF-1、전청단백수평월고.3.LgIRI적영향인소포괄SGA(OR=7.904,P=0.001)、출생체질량＜1 500 g(OR=8.737,P=0.019)、미추간생장(OR=11.706,P=0.000).결론 유인기추간생장정도월대,IR월저,IGF-1、전청단백수평월고;IR적영향인소포괄SGA、저출생체질량급미추간생장,차미추간생장영향최대.
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 infancy,but the level of IGF-1 and prealbumin was higher than that of no catch-up growth group (F =3.55,4.94),the difference had statistical significance (P ＜ 0.05) ; the better catch-up growth was associated with higher IGF-1 and prealbumin,but with lower LgIRI.(3) The risk factors for insulin resistance were SGA (OR =7.904,P =0.001),low birth weight ＜ 1 500 g (OR=8.737,P=0.019),and no catch-up growth (OR=11.706,P=0.000).Conclusions The better catch-up growth in infancy is associated with higher IGF-1 and prealbumin,but lower IR.The risk factors of IR include SGA,low birth weight and no catch-up growth,and the last being the major factor.
