小于胎龄儿婴儿期适宜生长轨迹及其与母亲孕晚期维生素D水平关联性的出生队列研究

发布时间：2018-02-08 09:31

本文关键词： 小于胎龄儿生长发育婴儿维生素D缺乏妊娠　出处：《安徽医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的运用潜类别模型建立小于胎龄儿(SGA)婴儿期多类别的生长轨迹,筛选代表性指标,描述赶上生长特点。通过不同生长轨迹对18个月龄前发育行为、BMI和生长受限的预测作用,判别出适宜的生长模式。并初步探讨孕晚期维生素D水平对SGA婴儿期生长轨迹的影响。方法采用出生队列研究设计,选取马鞍山优生优育队列中的足月单胎SGA 278例为研究对象,并以足月适于胎龄儿(AGA)为对照。随访测量婴儿3月龄、6月龄、9月龄和12月龄的身长、体重、头围指标。根据月龄将身长、体重和头围进行年龄别身长Z分(LAZ)、年龄别体重Z分(WAZ)、年龄别头围Z分(HCAZ)和身长别体重Z分(WLZ)转换。运用潜类别增长模型(LCGM)和增长混合模型(GMM)分别以LAZ、WAZ、HCAZ和WLZ建立生长轨迹模型,选取最优拟合模型和类别数,从中筛选具有代表性的生长轨迹指标。利用年龄发育进程问卷筛查评定SGA 6月龄和18月龄发育行为,评价6月龄、12月龄和18月龄婴幼儿BMI、生长受限情况,以出生队列的AGA为参照组,利用Logistic回归分析婴儿期不同生长轨迹与生长发育异常间的关联,作为判别适宜生长轨迹的依据。选取出生队列中SGA母亲孕晚期(孕32~39周)血清样本,采用放射免疫法测定孕晚期血清维生素D水平。收集母亲孕期人口学特征、维生素D检测季节、孕期维生素D和钙剂使用、孕前BMI、孕期增重、妊娠并发症资料;婴儿分娩方式、喂养方式、1岁内因病住院等信息。采用多分类Logistic回归分析孕晚期维生素D水平与SGA婴儿期生长轨迹的关联性。结果LAZ、WAZ、HCAZ和WLZ等4个指标采用GMM法建模结果均优于LCGM。LAZ、WAZ、HCAZ和WLZ间模型拟合比较显示WLZ的3类别模型结果最优。Ⅰ、Ⅱ和Ⅲ类别概率分别为21.8%、64.7%和13.5%,类别概率分布较为合理。Ⅰ、Ⅱ和Ⅲ类可分别代表SGA较快速度赶上生长、中等速度赶上生长和延迟赶上生长现象。3类别生长轨迹比较显示6月龄前是赶上生长的关键时期,6月龄后多数SGA出现放缓或回落;相反,少数SGA 9月龄后才出现缓慢追赶现象。控制混杂因素后,与AGA组相比,赶上Ⅰ组生长轨迹增加了6月龄时粗大动作、精细动作、解决问题和个人-社会交往能区接近/低于界值的风险,OR(95%CI)值分别为2.18(1.17~4.04)、2.24(1.17~4.28)、2.31(1.23~4.36)和2.36(1.28~4.34);但至18月龄时发育回归正常。6月龄时赶上Ⅰ组生长轨迹增加高BMI的风险(OR,95%CI:12.40,6.11~25.14)。赶上Ⅲ生长轨迹增加6月龄时粗大动作接近/低于界值的风险(OR值,95%CI:3.32,1.63~6.77);6月龄时生长受限率达16.1%,而其他组均低于3%。赶上Ⅱ组与AGA组的6月龄和18月龄发育行为异常率分布差异均无统计学意义;赶上Ⅱ组6月龄和18月龄的高BMI率低于AGA组,差异有统计学意义。依据发育评定结果将赶上Ⅰ、Ⅱ和Ⅲ类别分别命名为过快赶上生长、适宜赶上生长和延迟赶上生长3种模式。与适宜赶上生长模式相比,在控制了出生体重、维生素D检测季节、孕期维生素D和钙剂使用、婴儿性别、分娩方式、6月内喂养方式、1岁内住院情况、母亲年龄、母亲文化程度、孕前BMI、孕期增重、妊娠期高血压疾病和妊娠糖尿病等混杂后,孕晚期维生素D缺乏是SGA早期过快赶上生长(OR值,95%CI:2.59,1.20~5.61)和延迟赶上生长(OR值,95%CI:3.65,1.47~9.08)的危险因素。结论足月SGA婴儿期生长轨迹评定代表性指标为WLZ值,据此可识别出过快赶上生长、适宜赶上生长和延迟赶上生长3种模式。6月龄前是SGA婴儿期适度追赶生长关键期。婴儿期过快或延迟赶上生长均增加儿童早期发育行为异常和肥胖/生长受限风险。孕晚期维生素D缺乏是SGA婴儿期过快和延迟赶上生长的危险因素。
[Abstract]:The purpose of using the latent class model for gestational age (SGA) infant growth trajectories in many categories, screening the representative index, describing the growth characteristics of different growth. By catch up with the trajectory of development before the age of 18 months, the prediction effect of BMI and growth restriction, identify the suitable growth model. And to investigate the effect of late pregnancy vitamin D levels on SGA infant growth track. Using the method of birth cohort study design, select the Ma'anshan eugenics cohort singleton term SGA 278 cases as the research object, and the term appropriate for gestational age (AGA) as control. The 6 month old follow-up measurement of baby 3 month old, and 12 month old, 9 month old feet body weight, head circumference index. According to the age the length, weight and head circumference for age length Z (LAZ), weight for age Z score (WAZ), age Z (HCAZ) head circumference and length weight Z (WLZ) conversion. Using the latent class growth model (L CGM) and growth mixture model (GMM) respectively by LAZ, WAZ, HCAZ and WLZ to establish the growth trajectory model, selecting the optimal fitting model and the number of categories, screening the growth trajectory of the representative index. Using the development process from age 6 month old and 18 month old of SGA screening assessment questionnaire developed for evaluation, 6 month old, 12 month old and 18 month old of infants BMI, growth restriction, the birth cohort of AGA as the reference group, the regression analysis of different infant growth trajectories and growth associated anomalies between the use of Logistic, as the judgment basis. Selecting suitable growth trajectory in the SGA maternal birth cohort (32~39 gestational weeks) serum samples, late pregnancy serum vitamin D levels were determined by RIA. Collect demographic characteristics during pregnancy mothers, vitamin D testing season, vitamin D and calcium use during pregnancy, pre pregnancy BMI, weight gain during pregnancy, pregnancy complications; baby delivery, The feeding way 1 year old internal disease hospitalization information. By using multiple Logistic regression correlation analysis of late pregnancy level of vitamin D and SGA in infant growth trajectories. The results of LAZ, WAZ, HCAZ and WLZ 4 indicators by the method of GMM modeling results are better than those of LCGM.LAZ, WAZ, HCAZ and WLZ between the model fitting comparison showed that WLZ the 3 class model. The optimum results were I, II and III class probability was 21.8%, 64.7% and 13.5% categories, the probability distribution is more reasonable. I, II and III respectively on behalf of SGA quickly catch up with growth of medium speed growth and catch up with the delay phenomenon of.3 type growth catch growth trajectory comparison shows that the former 6 month old is to catch up with the key period the growth of 6 month old, after most of the SGA slowdown or decline; on the contrary, a few SGA 9 month old after a slow catch-up phenomenon. After controlling for confounding factors, compared with group AGA, group I catch up with the growth track increased by 6 month old large animals For fine motor, problem solving and personal - social interaction can close to / below risk limits, OR (95%CI) = 2.18 (1.17~4.04), 2.24 (1.17~4.28), 2.31 (1.23~4.36) and 2.36 (1.28~4.34); but to 18 month old growth to return to normal.6 months time I group the growth trajectory increases the risk of high BMI (OR, 95%CI:12.40,6.11~25.14). To catch up with the 6 month old increase in gross growth trajectory of action close to / below the risk limits (OR, 95%CI:3.32,1.63~6.77); 6 month old restricted growth rate reached 16.1%, while the other group was lower than that of 3%. group and AGA group II to catch up 6 month old and 18 month old growth abnormal behavior there were no significant differences in catch rate distribution; high BMI II Group 6 month old and 18 month old was lower than that of AGA group, the difference was statistically significant. On the basis of developmental evaluation results will catch up with I, II and III categories were named as too quick to catch up with the growth, growth and catch up with the appropriate delay time On the growth of 3 kinds of mode. With the appropriate catch growth model than in the control of the birth weight, vitamin D test season, vitamin D and calcium use during pregnancy, infant sex, delivery mode, June in feeding patterns, 1 years old hospitalized, mother's age, mother's education, pre pregnancy BMI, weight gain during pregnancy. Hypertensive disorders of pregnancy and gestational diabetes is mixed, pregnant late vitamin D deficiency is too fast to catch up with the growth of early SGA (OR, 95%CI:2.59,1.20~5.61) and delayed catch growth (OR, 95%CI:3.65,1.47~9.08) risk factors. Conclusion the term SGA infant growth trajectory evaluation of representative indexes for the WLZ value, which can identify too fast catch up growth, catch up with suitable growth and delayed catch-up growth 3 modes.6 months before the infant is SGA moderate catch-up growth critical period. The infant is too fast or delayed increase in children's early growth were to catch up with the development of abnormal behavior and obesity / / growth limited risk. Vitamin D deficiency in the late trimester of pregnancy is a risk factor for excessive and delayed infant growth in SGA.

【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R174

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