影响早产儿胃泌素、胃动素分泌及生长发育相关因素的临床研究

Clinical Study of the Correlation Factors to the Excretion of Gastrin, Motilin and Growth Development in Premature Infants

目的 探讨早产儿胃泌素、胃动素的分泌与胎龄、体重（body weight,BW）的关系及胃肠激素分泌、释放的影响因素.方法 选取2006年12月～2008年7月我科收治的新生儿127例,据胎龄分成早产儿组和足月儿组.早产儿组87例,根据胎龄分：～32w组、～34w组、～36w组;据出生体重分：～1499g组、～2499g组、≥2500g组;据给养方式分：正常喂养组29例,胃管组31例,全胃肠外组（Total Parenteral Nutrition,TPN）27例.取本院产科同期正常新生儿40例为对照组.早产儿组和对照组均于生后12h开奶前取血,第8天取空腹血,行胃泌素（gastrin,GAS）、胃动素（motilin,MOT）测定.结果 ①早产儿组12h内及第8天空腹血GAS和MOT水平明显低于对照组,有统计学意义（P＜0.05）.第8天GAS,MOT水平已达到或超过对照组开奶前水平,有统计学意义（P＜0.05）.②各组早产儿生后随日龄与奶量增加,GAS,MOT浓度均渐高.其中,正常喂养组、胃管组与TPN组比较均有统计学意义.③～1499g组和～2499g组间第1天和第8天空腹血GAS水平无显著差异,但两组均显著低于≥2500g组,有统计学意义（P＜0.05）.而3组不同体重生后第1天和第8天空腹血MOT水平差异无显著性（P＞0.05）.④正常喂养组和胃管组在体重以及身长增长分别与胃肠外组比较都有统计学意义（P＜0.05）.3组在头围增长方面比较无统计学意义（P＞0.05）.结论 ①早产儿的胃泌素、胃动素水平与胎龄、体重密切相关,随着胎龄、体重的增加,其胃肠激素分泌功能逐渐完善.②胃肠内营养刺激胃肠激素分泌和释放,使早产儿胃肠功能迅速发育成熟.

Objective To discuss the correlation factors to the excretion of gastrin,motilin and growth development of premature infants. Methods One-hundred and twenty-seven cases of newborn infants admitted to neonatal wards in our hospital from January 2006 to January 2008 were chosen in this study. They were divided into two groups according to gestational age ： premature group （ n = 87 ） and fullterm group （ n = 40 ）. The premature group was divided into 3 subgroups according to gestational age （ - 32W, - 34W, - 36W ） , birth weight （ - 1499g, - 2499g, ≥2500g） and the ways of feeding （ normal feeding group, gastric tube feeding group and total parenteral feeding group） respectively. The full-term newborns in control group were born in the same period in obstetric department of our hospital as the study group. Specimen collection and processing： premature infants and control group were taken 4ml fasting blood within 12 hours after birth and on the 8th day. Results （1）The level of fasting serum GAS and plasma MOT of premature infants in all groups was significantly lower than that of the control group during the first 12 hours and on the 8th day（ P 〈 0.05 ） , which in consistant with the increase of the age and the quantity of milk intake. （2）The level of fasting serum GAS and plasma MOT of all groups of premature infants gradually increased with age and the quantity of milk intake（ P 〈0.05 ）. （3）There was no significant difference between BW - 1499g group and BW - 2499g group in the level of serum GAS on the first and the 8th day, which were significantly lower than BW ≥ 2500g group（ P 〈 0.05 ）. There was no statistical significance in the level of fasting MOT among those groups （ P 〉 0.05 ）. （4）Compared with the parenteral nutrition group, the infants in normal feeding group and the gastric tube feeding group all had significant increase in body weight and length （ P 〈 0.05 ）. The increase of head circumference among these three groups was no statistical difference （ P 〉 0.05 ）. Conclusion （1）The level of gastrin and motilin in the premature infants is closely related to gestational age, and the secretion function of gastrointestinal hormone has improved with the increase of gestational age and birth weight. （2）Enteral nutrition is not only direct, but also to stimulate the secretion and releasing of gastrointestinal hormone,making gastrointestinal function in a rapid and adaptive growth and development in premature infants after birth.