广州市社区足月小样儿0~2岁体格发育的纵向研究

Longitudinal analysis of physical growth of term small for gestational age infants at 0 to 24 months old from communities in Guangzhou

目的了解足月小样儿生后2年内的体格发育和营养状况,为制定足月小样儿生长发育干预策略提供科学依据。方法采用前瞻性的研究方法,选取2016年1月—2018年4月广州出生的足月小样儿为小于胎龄儿(SGA)组,选取同种族、同社区、同年龄的足月正常体重儿为适于胎龄儿(AGA)组,定期对生长参数进行了纵向评估,比较两组儿童体格发育特点。结果1)SGA组生后各年龄组体重和身长Z评分均小于AGA组,但生后第一年Z评分呈上升趋势,体重增长(ΔZ评分为1.17±1.10)、身长增长(ΔZ评分为0.65±1.23)均大于AGA组。2)67.65%和50.98%的SGA在婴儿期出现体重和身长追赶生长;婴儿期生长速率与2岁时营养状况相关(P<0.01)。3)SGA组在各年龄的低体重、生长迟缓、消瘦率均高于AGA组,2岁时发生率在8%~15%。超重和肥胖率低于AGA组,2岁时超重率为2.94%。两组间低体重、生长迟缓和超重率比较,差异有统计学意义(χ^(2)=4.40、4.18、5.38,P<0.05);SGA组6月龄贫血患病率高达43.63%。结论足月小样儿生后一年内体重和身长均有追赶生长。营养不良发生状况不容忽视,应注意预防足月小样儿营养不良和6月龄贫血。

Objective To investigate the physical growth of small for gestational age(SGA)24 months after birth,so as to provide the scientific basis for making growth and development intervention strategies for SGA.Methods A prospective study was used to select SGA born from January 2016 to April 2018,receiving regular physical examination in community health-care service centers within 2 years after birth.Full-term appropriate for gestational age(AGA)infants during the same period were selected as controls.The weight and length of the infants were measured continuously.And after standardization,the growth level and growth rates were compared between the two groups.Results 1)The weight and length for age Z-scores in the SGA group were lower than those in the AGA group.In the SGA group,the weight and length for age Z-scores both showed an increasing trend in the 12 months after birth.But the weight gain(ΔZ:1.17±1.10)and length growth(ΔZ:0.65±1.23)of the SGA group were higher than those of the AGA group during infancy.2)Totally 67.65%of the infants showed catch-up growth in weight and 50.98%of infants showed catch-up growth in height.Weight and height growth rate at 0 to 12 months old was positively correlated with the nutritional status at 2 years old(P<0.01).3)The incidence rates of underweight,stunting and wasting were higher than those of the AGA group,and the incidence at 2 years old was 8%—15%.The incidence of overweight and obesity of SGA group was lower than that of the AGA group,the incidence of overweight at 2 years old was 2.94%.The differences in the incidence rates of underweight,stunting and overweight were significant between SGA group and AGA group(χ^(2)=4.40,4.18,5.38,P<0.05).The incidence of anemia of SGA group at 6 months old was 43.63%.Conclusions Small full-term infants have catch-up growth in weight and length within one year after birth.The occurrence of malnutrition should not be ignored,and attention should be paid to prevent malnutrition and anemia at 6 months of age in full-term infants.