低出生体重早产儿追赶性生长对胰岛素抵抗的影响

Effect of catch-up growth in low birth weight premature infants on insulin resistance

目的探讨低出生体重早产儿追赶性生长对胰岛素抵抗的影响。方法选择2011年1月至2014年12月在我院新生儿科治疗且进行随访的低出生体重早产儿160例为研究对象,按照体重与胎龄将其分为适于胎龄组(91例)和小于胎龄组(69例),根据随访时儿童的年龄分为1~6个月组、7~12个月组和1~3岁组。入组次日清晨取空腹静脉血6 m L,即刻检测血液生化指标,于采血当天进行体重和身长测定,计算胰岛素抵抗指数(IRI)、Ponderal指数、体重与身长标准差计分(SDS)。结果适于胎龄组的追赶生长发生率为68.1%(62/91),与小于胎龄组的60.9%(42/69),比较差异无统计学意义(P>0.05)。幼儿期追赶生长良好者的前白蛋白为(210.2±26.5)g/L、胰岛素生长因子-1为(162.4±29.1)mg/L,明显高于无追赶生长者的(176.2±28.4)g/L和(38.6±17.5)mg/L,差异均有统计学意义(P<0.05);空腹胰岛素抵抗指数(0.8±1.9)、空腹胰岛素水平[(5.3±1.5)pmol/m L]明显低于无追赶生长组[(1.7±1.6)、(8.1±1.6)pmol/m L](P<0.05)。各个年龄段追赶生长越大,前白蛋白、胰岛素生长因子-1的值越高,而胰岛素抵抗指数越小。各个年龄段追赶生长越大,前白蛋白、IGF-1的值越高,而Lg FINS越小。以胰岛素抵抗指数>1作为异常,Logistic回归结果显示出生体重<1 500 g、小于胎龄儿、未追赶生长为胰岛素抵抗指数异常的影响因素。结论幼儿期追赶性生长程度越高,则胰岛素抵抗性越低,前白蛋白、胰岛素生长因子-1水平越高;低出生体重、小于胎龄儿、未追赶生长是胰岛素抵抗指数异常的影响因素。

Objective To explore the effect of low birth weight premature infants with catch-up growth on insulin resistance. Methods From January 2011 to December 2014, 160 cases of low birth weight premature infants, who admitted to the Department of Pediatrics of our hospital, were selected as the research objects. According to weight and gestational age, the premature infants were divided into appropriate for gestational age(AGA, 91 cases) and small for gestational age(SGA, 69 cases); According to the follow-up of infants age, the premature infants were divided into 1~6months group, 7~12 months group and 1~3 years old group. On the next day of entering group, about 6 m L fasting venous blood was drawn and used to detect the blood biochemical indexes. In the meantime, insulin resistance index(IRI),ponderal index, weight and height standard deviation score(SDS) were measured. Results There was no statistically significant difference between AGA group and SGA group in the incidence rate of catch-up growth(68.1%(62/91) vs 60.9%(42/69), P>0.05). The prealbumin and insulin growth factor-1(IGF-1) in infants who did catch up [(210.2 ± 26.5) g/L,(162.4±29.1) mg/L] were significantly higher than infants who did not catch up [(176.2±28.4) g/L,(38.6±17.5) mg/L](P<0.05); The insulin resistance index and fasting insulin level in infants who did catch up [(0.8±1.9),(5.3±1.5) pmol/m L] were significantly lower than that of infants who did not catch up [(1.7±1.6),(8.1±1.6) pmol/m L](P<0.05). In all age groups, the incidence rate of catch-up growth increased along with the increase of prealbumin and IGF-1, and the decrease of the IRI level. Taking insulin resistance index>1 as abnormal, logistic regression analysis showed that birth weight<1 500 g, SGA and no catch-up growth were the impact factors of abnormal insulin resistance index. Conclusion Catch-up growth degree in early childhood has a negative relationship with insulin resistance, and a positive relationship with prealbumin and IGF-1. Low birth weight, SGA and no catch-up growth are the impact factors of abnormal insulin resistance index.