咸阳市早产儿、低体重儿幼儿期追赶生长与胰岛素敏感性关系

发布时间：2018-07-07 12:33

本文选题：早产儿及低体重儿 + 追赶生长　；参考：《陕西中医学院》2014年硕士论文

【摘要】：目的：随着全球经济、卫生条件的改善和医疗水平的提高，早产儿（premature baby胎龄37周）、低出生体重儿（Low birth weight LBW,出生体重2500g）的存活率越来越高。长期以来，追赶生长都被认为是机体从发育迟缓或生长停滞的病理状态中加速恢复的过程，，是机体的一种自我代偿和保护机制。因此本研究旨在探讨咸阳市早产儿及低体重儿幼儿期追赶生长代谢特征及与胰岛素敏感性的关系。方法：对2010年4月～2012年4月215例咸阳市就诊咸阳市妇产医院和咸阳市彩虹医院儿科2010年4月-2012年4月出生的早产儿(胎龄37周)、低出生体重儿(LBW，出生体重2500g),除外有难产史，新生儿畸形及严重缺血缺氧疾病，围产窒息以及母亲妊娠糖尿病，神经系统疾病的幼儿，在征得家长同意后均列为研究对象。对照组30例随机选自同期出生的健康适于胎龄儿（AGA）,上述正常儿及早产儿及低体重儿诊断标准依据第4版《实用新生儿学》制定。计量资料用均数±标准差(x s)表示，计数资料以百分数(%)表示，所得结果运用SPSS17.0统计软件进行方差分析、t检验和相关分析等。结果：SGA儿出生时测得身高和体重SDS值均低于AGA儿，餐前空腹血糖测量两组比较差异无显著性，但是胰岛素水平和HOMA值SGA组明显高于AGA组;HOMA值高于AGA组；SGA儿追赶生长速度与胰岛素及HOMA值呈明显负相关(P0.05)；2岁时SGA儿组和AGA儿组相比，身高和体重SDS值无明显差异性，测餐前空腹血糖、胰岛素水平高于AGA组，HOMA值也高于AGA组，SGA儿经过追赶生长，测的值达到正常水平;2岁时测甘油三酯和总胆固醇SGA组和AGA组相比，SGA组显著高于AGA组；在SGA儿中11名体重身长均未出现追赶生长者,其胰岛素水平和HOMA值均显著高于出现追赶生长组[胰岛素(13.750.99)mU/L vs (5.870.85) mU/L, P0.01; HOMA值(2.00.64)v s (1.350.26), P 0.01] 结论：1.SGA儿出生时测得身高、体重和身高体重的SDS值均低于AGA儿，餐前空腹血糖测量两组比较差异无显著性，但是胰岛素水平值和HOMA值SGA组明显高于AGA组;HOMA值高于AGA组;在出生时SGA儿和AGA儿身高、体重、血糖和胰岛素及HOMA值有明显差异，影响危险因素有多种；2.2岁时SGA经过追赶生长及后天营养干预等，测的身高和体重及身高、体重的SDS值值达到正常水平，胰岛素水平值和HOMA值SGA组略高于AGA组；3.SGA儿在经过追赶生长后，测甘油三酯和总胆固醇已达到正常水平，堆积的内脏脂肪与血脂有明显关系；4.SGA在2岁内追赶速度最快，通过喂养方式、后天体育锻炼及父母后期生活干预等，可以加快其追赶速度，早产儿及低体重儿追赶生长速度与胰岛素敏感性密切相关，追赶速度越慢，胰岛素敏感性越低。
[Abstract]:Objective: with the improvement of global economy, health condition and medical treatment, the survival rate of low birth weight (low birth weight 2500g) is increasing in premature infants at 37 weeks of gestation. For a long time, chasing growth has been regarded as a process of accelerating recovery from the pathological state of growth retardation or stagnation, as well as a mechanism of self-compensation and protection. The aim of this study was to investigate the relationship between the catch-growth metabolism and insulin sensitivity of premature and low birth weight infants in Xianyang. Methods: from April 2010 to April 2012, 215 cases of premature infants (gestational age 37 weeks) born in Xianyang Gynecology Hospital and Xianyang Rainbow Hospital from April 2010 to April 2012, low birth weight infants (LBW, birth weight 2500g), with the exception of history of dystocia, were studied. Children with neonatal malformation, severe ischemic and hypoxic diseases, perinatal asphyxia, maternal diabetes mellitus and neurological diseases were all included in the study with parental consent. In the control group, 30 cases of healthy and suitable gestational age (AGA) were randomly selected from the same period. The diagnostic criteria of the above mentioned normal infants, premature infants and low birth weight infants were formulated according to the 4th edition of practical Neonatology. The measured data were expressed as mean 卤standard deviation (x s), and the counting data were expressed as percentage (%). The results were analyzed by ANOVA and correlation analysis using SPSS 17.0 statistical software. Results the height and weight of SGA were lower than that of AGA at birth. There was no significant difference in fasting blood glucose between the two groups, but the insulin level and Homa in SGA group were significantly higher than those in AGA group and AGA group. There was significant negative correlation between the catch-up growth rate of SGA and insulin and HOMA (P0.05). There was no significant difference in height and SDS between SGA and AGA at the age of 2. Fasting blood glucose was measured before meal. The level of insulin was higher than that of AGA group (Homa) and higher than AGA group (P < 0.05). The level of insulin was significantly higher in SGA group than in AGA group at the age of 2 years, and the level of triglyceride and total cholesterol in SGA group was significantly higher than that in AGA group. The insulin level and Homa value in 11 SGAs were significantly higher than those in the catch-up growth group [insulin (13.750.99) MU / L vs (5.870.85) MU / L, P0.01; Homa (2.00.64) v s (1.350.26), P 0.01] conclusion: 1. The SDS values of weight and height weight were lower than those of AGA children. There was no significant difference in fasting blood glucose measurement between the two groups, but the insulin level and HOMA values in SGA group were significantly higher than those in AGA group, and the height and weight of SGA and AGA children at birth were significantly higher than those in AGA group. There were significant differences in blood glucose, insulin and Homa. The risk factors were SGA after catch-up growth and postnatal nutrition intervention at 2.2 years old. The height, weight, height and SDS value of body weight reached the normal level. The levels of insulin and Homa in SGA group were slightly higher than those in AGA group. 3. After catching up and growing, triglyceride and total cholesterol had reached normal level, and the accumulation of visceral fat was significantly related to blood lipids. 4. SGA was the fastest catching up rate within 2 years of age. The catch-up rate of premature infants and low birth weight infants was closely related to insulin sensitivity. The slower the catching up speed, the lower the insulin sensitivity.
【学位授予单位】：陕西中医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.6

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