出生巨大儿胰岛素抵抗和儿童期体格发育、血糖、血脂的相关性研究

Correlation between insulin resistance and childhood physical development,blood glucose,and lipids in macrosomia

目的探讨出生巨大儿胰岛素抵抗(IR)和儿童期体格发育、血糖、血脂的相关性。方法选取武汉市蔡甸区人民医院产科2013年1月至2014年2月出生的巨大儿52例,记为巨大儿组,根据胎龄、性别1∶1匹配选取该院同期出生的正常体质量儿52例,作为正常儿组。检测两组新生儿出生时的空腹血糖(FBG)和胰岛素水平,计算胰岛素抵抗指数(HOMA-IR),并根据有无IR将巨大儿组分为IR组(18例)与非IR组(31例)。跟踪随访巨大儿组和正常儿组体格发育情况和糖脂代谢,比较IR组、非IR组和正常儿组体格指标[包括身高、体质量、身体质量指数(BMI)]和FBG水平、血脂水平[包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)],采用Pearson相关性分析法分析巨大儿HOMA-IR与体格发育、血糖、血脂的相关性。结果随访期间巨大儿组失访3例,正常儿组失访5例,两组出生时性别、胎龄及TC、LDL水平比较差异无统计学意义(P>0.05);巨大儿组出生时身长、体质量、BMI、胰岛素水平、HOMA-IR、TG水平高于正常儿组,FBG、HDL水平低于正常儿组(P<0.05)。IR组1、3、5、8岁[(126.43±6.74)cm比(130.24±3.24)cm]时身高均低于非IR组,8岁时身高低于正常儿组,非IR组1、3岁时身高均高于正常儿组(P<0.05);IR组8岁时体质量高于非IR组[(32.41±4.19)kg比(28.67±4.23)kg],1、3、5、8岁时体质量高于正常儿组(P<0.05);IR组1、3、5、8岁时BMI均高于非IR组[8岁:(20.13±2.57)kg/m^(2)比(16.94±1.79)kg/m^(2)]和正常儿组(P<0.05)。IR组1、5、8岁时FBG水平均高于非IR组[8岁:(5.26±0.98)mmol/L比(4.71±0.75)mmol/L]和正常儿组(P<0.05);IR组3岁时TG水平高于正常儿组,5、8岁时TG水平均高于非IR组[8岁:(1.16±0.44)mmol/L比(0.86±0.34)mmol/L]和正常儿组(P<0.05);IR组1、3岁时HDL水平低于正常儿组(P<0.05)。Pearson分析结果显示HOMA-IR与儿童期体质量、BMI、FBG水平、TG水平均呈正相关(P<0.05),与儿童期身高呈负相关(P<0.05)。结论巨大儿出生时HOMA-IR高于正常儿,且出生巨大儿IR与儿童期体质量、BMI、FBG、TG呈正相关,与儿童期身高呈负相关,提示出生巨大儿IR可能对儿童期体格发育、糖脂代谢有一定影响。

Objective To explore the correlation between insulin resistance and childhood physical development,blood glucose,and lipids in macrosomia.Methods Fifty-two macrosomia infants born in the Obstetrics Department of Caidian District People's Hospital of Wuhan from January 2013 to February 2014 were selected as the macrosomia group.52 normal-weight infants born at the same time in the hospital were selected as the normal infant group according to the gestational age and sex 1∶1 matching.Fasting blood glucose(FBG)and insulin levels at birth were measured in both groups,and insulin resistance index(HOMA-IR)was calculated,and the macrosomia group was assigned into IR group(n=18)and non-IR group(n=31)based on the presence or absence of insulin resistance.The physical development and glucose and lipid metabolism of macrosomia group and normal infant group were followed up.The physical indexes[including height,body mass and body mass index(BMI)],and the levels of FBG and blood lipid[including total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL),and low-density lipoprotein(LDL)]of IR group,non-IR group and normal infant group were compared.Pearson correlation analysis was used to analyze the correlation between HOMA-IR and physical development,blood glucose,and blood lipids in macrosomia.Results During the follow-up period,3 children in the macrosomia group were lost to follow-up,and 5 children in the normal infant group were lost to follow-up.There were no significant differences in gender,gestational age,and the levels of TC and LDL between the two groups at birth(P>0.05).The body length,body mass,BMI,insulin level,HOMA-IR,and TG level at birth in the macrosomia group were higher than those in the normal infant group,while the levels of FBG and HDL were lower than those in the normal infant group(P<0.05).The height of the IR group at the age of 1,3,5 and 8[(126.43±6.74)cm vs.(130.24±3.24)cm]was lower than that of the non-IR group,and the height of the IR group at the age of 8 was lower than that of the non-IR group,and the heights of the non-IR group at the age of 1 and 3 were higher than those of the normal infant group(P<0.05).The body mass of the IR group at the age of 8 was higher than that of the non-IR group[(32.41±4.19)kg vs.(28.67±4.23)kg],and the body mass of the IR group at the ages of 1,3,5 and 8 was higher than that of the non-IR group(P<0.05).The BMI of IR group at the ages of 1,3,5 and 8 was higher than that of non-IR group[8 years old:(20.13±2.57)kg/m^(2) vs.(16.94±1.79)kg/m^(2)]and normal infant group(P<0.05).The FBG levels in the IR group at the ages of 1,5,and 8 were higher than those in the non-IR group[8 years old:(5.26±0.98)mmol/L vs.(4.71±0.75)mmol/L]and the normal infant group(P<0.05).The TG level in the IR group was higher than that in the normal infant group at 3 years old,and the TG levels in the IR group at the ages of 5 and 8 were higher than those in the non-IR group[8 years old:(1.16±0.44)mmol/L vs.(0.86±0.34)mmol/L]and the normal infant group(P<0.05).The HDL levels in the IR group at the ages of 1 and 3 were lower than those in the normal infant group(P<0.05).Pearson analysis results showed that HOMA-IR was positively correlated with childhood body mass,BMI,FBG level,and TG level(P<0.05),and it was negatively correlated with childhood height(P<0.05).Conclusions HOMA-IR of macrosomia at birth is higher than that of normal infants.The insulin resistance of macrosomia at birth are positively correlated with childhood body mass,BMI,FBG and TG,and negatively correlated with childhood height,suggesting that insulin resistance in macrosomia may have a certain impact on physical development and glucose and lipid metabolism in childhood.