早产儿宫外生长发育迟缓与血清脂联素的关系

Relationship between premature extrauterine growth retardation and serum adiponectin

目的 调查早产儿在出院时宫外发育迟缓的发生率（≤P10宫内生长曲线）并探讨其与血清脂联素的关系。方法 选择2012年9月-2013年3月出生于郑州大学第三附属医院,并在24 h内入住该院新生儿重症监护室的早产儿92例为观察对象,选择同时期住院的足月儿20例作为对照,具有完整的出生体重、头围和出院体重、头围,宫内生长曲线值采用中国15城市不同新生儿出生体重、头围值（1986-1987年）;采用酶联免疫法测定血清脂联素水平。统计学分析采用t检验或χ^2检验。结果 92例早产儿宫外发育迟缓的发生率以出院体重评价为43.48%,以出院头围评价为21.74%。EUGR的发生率随出生体重及胎龄的增加而减少（P〈0.05）;早产组生后第1天血清脂联素水平[（11.62±4.67）mg/L]明显低于足月组[（23.16±3.94）mg/L]（P〈0.01）;早产组生后第14天血清脂联素水平[（17.86±4.56）mg/L]比第1天明显升高（P〈0.01）;宫外发育迟缓组脂联素水平生后第14天[（13.16±4.11）mg/L]与第1天[（9.13±4.26）mg/L]比较无统计学差异（P〉0.05）,非宫外发育迟缓组生后第14天脂联素水平[（21.75±3.96）mg/L]较生后第1天[（12.74±4.12）mg/L]明显升高（P〈0.01）。结论宫外发育迟缓在早产儿中仍有较高的发生率,出生体重低的早产儿发生率相对较高;早产儿血清脂联素水平随日龄的增加逐渐升高,宫外发育迟缓早产儿血清脂联素水平随日龄的增加无明显增加,因此脂联素可能成为提示早产儿发生宫外发育迟缓的敏感指标。

Objective To survey the incidence rate of premature extrauterine growth retardation （EUGR） （ ≤P10 intrauterine growth curve） after leaving the hospital, explore its relationship with serum adiponectin. Methods Ninety-two premature infants born in the hospital from September 2012 to March 2013 and admitted to NICU in the hospital within 24 hours after birth were selected as study objects, twenty mature infants during the same period were selected as control group. The survey contents included birth weight, head circumstance, weight and head circumstance when leaving the hospital; intrauterine growth curve values adopted birth weight and head circumstance of different neonates from 15 cities in China from 1986 to 1987; ELISA was used to detect serum adiponectin levels ; t test orХ^2 test was used for statistical analysis. Results The incidence rates of EUGR in the hospital were 43.48% and 21.74% for weight and head circumference, respectively. The incidence rate of EUGR decreased with the increases of birth weight and gestational age （ P〈0.05 ） . The serum adiponectin level on the first day after birth in preterm group was （ 11.62±4. 67） mg/L, which was statistically significantly lower than that in fullterm group [ （23.16 ±3.94） mg,/L] （P〈0. 01 ） ; in preterm group, the serum adiponectin level on the 14th day after birth was （ 17.86 ± 4. 56） mg/L, which was statistically significantly higher than that on the first day after birth （P〈0. 01 ） ; in EUGR group, there was no statistically significant difference in serum adiponectin level between the 14th day after birth [ （ 13.16±4. 11 ） mg/L] and the first day after birth [ （9. 13±4. 26） mg/L] （P〉0. 05） ; in non-EUGR group, the serum adiponectin level on the 14th day after birth was （21.75± 3.96） mg/L, which was statistically significantly higher than that on the first day after birth [ （ 12. 74±4. 12） mg/L] （P〈0. 01 ） . Conclusion There is still high EUGR incidence rate in premature infants. The incidence rate of EUGR among premature infants with low birth weight is relatively high ; serum adiponectin level in premature infant increases gradually with age, serum adiponectin level in EUGR premature infant does not increase significantly with age, so serum adiponectin might be a sensitive indicator for EUGR among premature infants.