【摘要】 目的探讨1~36个月小于胎龄(SGA)儿血清脂联素水平及其与胰岛素抵抗(IR)的关系。方法选择在本院产科分娩或新生儿科住院,出生日期为2001年12月至2004年12月(收集样本时年龄为1~36个月)并被确诊为SGA的新生儿纳入SGA组(n=71)。选择同期在本院儿童保健门诊接受体检的适于胎龄(AGA)儿,出生日期与SGA组一致,纳入AGA组(n=31)。观察两组个体1~36个月时体格生长情况,检测其空腹血糖(FPG)、空腹胰岛素(FINS)和血清脂联素水平,计算稳态模型胰岛素抵抗指数(Homa-IR)和稳态模型胰岛素敏感指数(Homa-IAI)。两组均排除先天性疾病、遗传代谢病、脑瘫、新生儿缺氧缺血性脑病及结核、肝炎、肾病综合征等慢性疾病患儿(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。结果①SGA组71例受试者中,25例因各种原因予以排除,最终符合纳入和排除标准的SGA组受试者为46例。②SGA组与AGA组受试者性别、年龄比较,差异无统计学意义(χ2=0.377,P>0.05;χ2=0.064,P>0.05)。另外,两组受试者生后喂养方式及纳入时合并相关内科疾病等比较,差异无统计学意义(P>0.05)。③SGA组与AGA组生长发育指标比较,除体重指数(BMI),差异无统计学意义(P>0.05)外,体重、体重Z积分、身高、身高Z积分、胸围等,差异均有统计学意义(P<0.05)。④SGA组和AGA组儿童的FPG,FINS,Homa-IR和Homa-IAI比较,差异均无统计学意义(P>0.05)。⑤血清脂联素与BMI呈负相关(r=-0.304,P<0.05),与年龄、性别、FPG及FINS水平无相关性(P>0.05)。⑥SGA组与AGA组的血清脂联素水平比较,差异有统计学意义(P<0.05),SGA组血清脂联素水平低于AGA组。⑦血清脂联素与体重、体重Z积分、身高、身高Z积分、BMI、年龄、FPG和FINS的多元线性回归分析显示,与BMI具相关性(P<0.05),是血清脂联素的影响因素,复相关系数R=0.336,确定系数R2=0.113。结论 SGA儿在1~36个月尚未出现IR,但血清脂联素水平降低,表明其出现IR的危险性高于AGA儿。更多还原

【Abstract】 Objective To investigate the relationship between the level of serum adiponectin and insulin resistance(IR) in children aged 1-36 months born small for gestational age(SGA).Methods A total of 71 children born SGA and 31 children born appropriate for gestational age(AGA) with the same age were assigned to SGA group(n=71) and AGA group(n=31).The concentration of serum adiponectin,fasting plasma glucose(FPG),and fasting insulin(FINS) were measured in these two groups.Anthropometric indicators were also obtained at the same time.Insulin sensitivity index and IR index both were calculated.Those who had congenital diseases,metabolism diseases,cerebral palsy,hypoxic ischemic encephalopathy,tuberculosis, hepatitis,nephrotic syndrome and some other chronic diseases are excluded from this study.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University.Informed consent was obtained from all participants.Results ①Among the 71 subjects in SGA group,25 were eliminated for some kinds of reason.Finally 46 children corresponded the conclusion and exclusion standard.②There were no difference in gender and age between SGA and AGA groups(χ2=0.377,P>0.05;χ2=0.064,P>0.05).In addition,there were no difference in the feeding after birth and complication(P>0.05).③The weight,weight Z score,height,height Z score and chest circumference were found significant difference between two groups(P<0.05) except body mass index(BMI).④There were no differences in the levels of FPG,FINS and homeostasis model assessment insulin sensitivity index(Homa-IAI) and homeostasis model assessment insulin resistance index(Homa-IR) between two groups(P>0.05).⑤There was a negative correlation between the level of serum adiponectin and BMI(R=-0.304,P<0.05),but adiponectin did not correlate with age,gender,FPG and FINS(P>0.05).⑥The level of serum adiponectin in SGA group was lower than that in AGA group and statistically significant difference was showed(P<0.05).⑦Multiple linear regression analysis showed a positive correlation between the level of serum adiponectin and BMI(R=-0.304,P<0.05),BMI was the influencing factor of serum adiponectin(R=0.336,R2=0.113).Conclusion Children of SGA who aged 1-36 months did not achieve IR yet.There was a negative correlation between serum adiponectin and BMI.The level of serum adiponectin is reduced.Children of SGA had higher risk to develop IR than AGA infants.更多还原