早产儿瘦素质量浓度与早期静脉营养及生长发育相关性探讨

The study of the relationship between leptin and early parenteral nutrition as well as growth of premature infants

目的探讨瘦素质量浓度与早期静脉营养及生长发育的关系。方法新疆医科大学第一附属医院新生儿科于2005-01—2006-02,将收治的86例早产适于胎龄儿用随机数字表法分为观察组(早期微量喂养同时辅助胃肠外营养组)45例和对照组(单纯早期微量喂养组)47例,分别测定脐血及第7天血清瘦素质量浓度,同时监测营养状况和生长发育指标,并作对比分析。结果(1)观察组与对照组脐血瘦素质量浓度分别为(4.6±3.7)ng/mL、(4.8±2.2)ng/mL,生后第7天两组瘦素质量浓度分别为(4.3±2.2)ng/mL、(3.1±1.7)ng/mL。对照组第7天血清瘦素质量浓度明显低于脐血(P<0.05),而观察组其差异无统计学意义(P>0.05)。(2)脐血瘦素质量浓度与出生体重、胎龄成正相关(r=0.56、r=0.67)。(3)观察组第7天热卡及蛋白质摄入量、血清瘦素质量浓度、皮褶厚度变化值与对照组相比,差异有统计学意义(P<0.05)。结论对早产儿应尽早喂养,同时需要胃肠外营养作为肠内营养的补充。瘦素可作为新生儿营养效果判定的实验室指标之一。

Objective To investigate the relationship between serum leptin and early nutrition as well as growth of premature infants. Methods Eighty-six cases of premature appropriate for gestational infants were divided into the group of the parenteral nutrition and control group to measure by radioimmunoassay （RIA） their leptin concertrations in the umbilical cord blood and serum on the 7^th day after birth. At the same time, daily nutrition state and physical growth indexes were examined. The correlation among leptin concentrations in cord blood, serum blood on 7^th day after birth and daily intake of the quantity of energy, protein,variance of weight, MAC and the variance of skin-fold thickness were studied. Resuits （1） The levels of umbilical cord blood leptin were （4.6±3.7）ng/mLand （ 4. 8±2. 2 ） ng/mL in the group of the parenteral nutrition and control group respectively. The levels of serum leptin on 7^th day after birth were （ 4. 3±2. 2 ） ng/mL and （ 3.1±1.7 ） ng/mL in the above two groups. The level of serum leptin on 7^th day was significantly lower than that of umbilical cord blood in infants of control group （ P 〈 0. 05 ）. （ 2 ） The level of umbilical cord blood leptin correlated positively with gestational age and birth weight （ r = 0. 56, r = 0. 67 ）. （ 3 ） Daily intake of the quantity of energy, protein, leptin and the variance of skin-fold thickness on 7^th day after birth were significantly different between the two groups （ P 〈 0. 05 ）. Conclusion Sufficient supply of energy and protein should be ensured in premature infants. It is important to feed premature infants as early as possible. Premature infants should receive parenteral nutrition as supplements to enferal feeding. Leptin is worthy of recommendation as the laboratory evidence.