脐血胰岛素、血糖及前白蛋白与胎儿宫内生长迟缓的关系

对25例宫内生长迟缓儿（IUGR）及25例正常出生体重儿母亲及脐血血清胰岛素、生长激素、血清蛋白及血糖水平进行了检测。给另：IUGR组母亲血糖、白蛋白及前白蛋白水平均低于对照组（P＜0．05），脐血白蛋白、前白蛋白、胰岛囊、血糖、胰岛素恤据比伍也低于对照组，而两组生长还囊水平无差异。相关分析表明出生体重与母亲血糖、脐血胰岛素、血糖、胰岛素恤糖及前白蛋白水平呈显著正相关。提出胰岛素与胎儿生长密切相关，生长激素作用较小，而IUGR、组脐血胰岛素/血糖降低，推测IUGR婴儿胰腺β细胞功能不足，生后血糖调节功能差．     

脐血可溶性瘦素受体与胎儿生长发育关系探讨

目的：瘦素是肥胖基因的蛋白产物,除参与调节机体能量代谢外,与胎儿的生长发育密切相关,但其作用机制尚不清楚。本研究旨在探讨脐血可溶性瘦素受体与胎儿生长发育的关系及其可能机制。方法：67例足月新生儿根据出生体重分为小于胎龄儿(SGA)组23例,适于胎龄儿(AGA)组44例。采用ELISA法测定脐血和母血中瘦素及可溶性瘦素受体水平,并采用体脂含量估测新生儿营养状态。结果：①脐血可溶性瘦素受体水平与脐血瘦素水平及新生儿出生体重、体脂含量呈负相关(r分别为-0.405,-0.366,-0.356,P均0.05)。③SGA组脐血可溶性瘦素受体明显高于AGA组［(18.24±6.02) ng/ml vs (13.80±4.37) ng/ml］,P<0.01;而SGA组的瘦素含量低于AGA组［(6.79±4.59) ng/ml vs (16.30±11.62) ng/ml］,P<0.01。④脐血可溶性瘦素受体水平男性高于女性［(16.89±4.37) ng/ml vs (13.95±5.29) ng/ml］,P<0.05;而脐血瘦素水平则是男性低于女性［(10.28±8.28) ng/ml vs (15.70±12.11) ng/ml］,P<0.05。结论：可溶性瘦素受体可能通过对血清中游离瘦素水平的调节实现对胎儿生长发育的调控作用。同时测定瘦素和可溶性瘦素受体可能更有利于进一步了解瘦素的病理生理作用机制。     

瘦素在宫内发育迟缓婴儿追赶生长中的作用

目的通过对胎儿宫内发育迟缓(IUGR)儿与正常儿生后1岁内血清瘦素(Leptin)水平的动态监测,探讨瘦素在IUGR儿追赶生长中的作用.方法随机选择资料完整的新生儿83例,其中IUGR组43例,正常组40例,进行跟踪随访,采用放免法测定血清瘦素水平.结果出生时IUGR儿血清瘦素水平(4.77±2.64)ng/ml,明显低于正常组(8.69±5.52)ng/ml,瘦素与体重指数(BMI)呈显著相关性(IUGR组r=0.37,P＜0.01,正常组,r=0.57,P＜0.001),随月龄增加,IUGR组BMI与正常组比较无显著性差异,而出生3、6、12个月IUGR组血清瘦素水平(ng/ml)明显上升,并显著高于正常组(3.97±1.94比3.42±1.56,4.29±.09比3.78±1.15,4.11±0.98比3.53±1.23),IUGR组瘦素水平与BMI无显著相关性,而正常组瘦素与BMI有一定的相关性.结论IUGR儿瘦素水平的升高可能与瘦素抵抗或脂肪组织功能缺陷有关,瘦素作为生长促进因子参与生后个体的发育,是IUGR儿发生追赶生长的主要原因.     

新生儿血清瘦素水平与生长发育关系研究

目的：探讨新生儿血清瘦素与生长发育的关系。方法：采用放射免疫法检测80例新生儿静脉血和脐血瘦素水平,其中66例足月儿分为大于胎龄儿(LGA)组18例,适于胎龄儿(AGA)组32例,小于胎龄儿(SGA)组16例。采用Rohrer’s指数=出生体重(g)×100/身长(cm)~3估测新生儿营养状态。结果：早产儿血清瘦素水平明显低于足月儿[(0.66±1.03)ng/ml vs(3.59±2.16)ng/ml],P<0.01;足月儿中AGA血清瘦素水平[(3.06±0.96)ng/ml]明显低于LGA[(4.03±2.22)ng/ml],而高于SGA[(1.13±1.98)ng/ml];足月新生儿血清瘦素水平与Rohrer’s指数、新生儿体重、胎龄呈显著正相关(r=0.61,0.68,0.62,P均<0.01)。结论：新生儿体内瘦素是反映新生儿的发育和营养状态的有用指标。[中国当代儿科杂志,2003,5(1):29-30]     

新生儿脐血瘦素水平测定及相关因素分析

目的测定脐血瘦素(leptin)水平并分析其相关因素,以探讨瘦素在胎儿生长发育中的作用.方法采用放射免疫法测定80例新生儿脐血瘦素水平,其中早产儿16例,足月儿64例.足月儿又分为小于胎龄儿11例,适于胎龄儿31例,大于胎龄儿22例.结果早产儿瘦素水平明显低于足月儿(4.25±3.19ng/mlvs9.86±5.50ng/ml,P＜0.001),足月儿中适于胎龄儿瘦素水平(8.91±5.20ng/ml)显著高于小于胎龄儿(5.17±2.46ng/ml)而低于大于胎龄儿(13.56±4.67ng/ml);脐血瘦素与胎龄、出生体重、身长、Kaup指数、头围、胎盘重量、脐血胰岛素、血脂等呈正相关关系;多元逐步回归分析表明体重、性别、胎龄是脐血瘦素的主要相关因素.结论各组新生儿瘦素水平有显著差异,体重、性别、胎龄是其主要相关因素,故瘦素对胎儿生长发育起着重要作用,是胎儿宫内生长发育的重要调控因子.     

高蛋白质喂养对生后早期营养不良的宫内生长迟缓大鼠糖代谢的远期影响

目的：探讨高蛋白质喂养对生后早期营养不良的宫内生长迟缓(IUGR)大鼠糖代谢的远期影响。方法：采用被动吸烟方法制备胎儿宫内生长迟缓大鼠模型。正常新生鼠仔42只和IUGR新生鼠仔129只随机分为以下4组：①正常对照组,②IUGR模型组,此两组均予20%常规蛋白饲料喂养至实验结束。③IUGR低蛋白组,④IUGR高蛋白组,此两组生后均予8%低蛋白饲料喂养4周,然后分别给予常规蛋白,或30%高蛋白饲料喂养至实验结束。各组大鼠分别在第4,6,48周做糖耐量和胰岛素释放试验,并计算胰岛素敏感指数(ISI)。结果：①IUGR高蛋白组和IUGR低蛋白组大鼠至48周时空腹血糖均呈上升趋势,分别为(5.97±0.88) mmol/L和(5.24±1.35) mmol/L,胰岛素水平明显升高,分别为(42.28±13.36) μU/ml和(31.22±3.36) μU/ml,ISI进一步下降,尤以IUGR高蛋白组改变为明显(1.32±0.56),两组与正常对照组［空腹血糖(4.46±1.11) mmol/L、胰岛素水平(15.82±1.63) μU/ml和ISI(2.80±0.15)］比较差异均有显著性(P<0.05或P<0.01 ;②IUGR模型组大鼠至48周时空腹血糖正常,胰岛素亦基本恢复正常,但糖负荷后血糖和胰岛素高峰浓度仍明显升高,分别为(11.39±1.23) mmol/L和(32.16±4.76) μU/ml,与正常对照组(7.99±0.92) mmol/L和(21.70±2.09) μU/ml比较差异有显著性 (P<0.05)。结论： 宫内和生后早期营养不良大鼠,若长期摄入高蛋白饮食,可出现明显的糖耐量减低和胰岛素抵抗,提示宫内和生后早期的营养状况对机体糖代谢均具有重要的远期影响。     

瘦素在宫内发育迟缓婴儿追赶生长中的作用

目的通过对胎儿宫内发育迟缓(IUGR)儿与正常儿生后1岁内血清瘦素(Leptin)水平的动态监测,探讨瘦素在IUGR儿追赶生长中的作用。方法随机选择资料完整的新生儿83 例,其中IUGR组43例,正常组40例,进行跟踪随访,采用放免法测定血清瘦素水平。结果出生时IUGR儿血清瘦素水平(4．77±2．64)ng／ml,明显低于正常组(8．69±5．52)ng／ml,瘦素与体重指数(BMI)呈显著相关性(IUGR组r=0．37,P<0．01,正常组,r=0．57,P<0．001),随月龄增加, IUGR组BMI与正常组比较无显著性差异,而出生3、6、12个月IUGR组血清瘦素水平(ng／ml)明显上升,并显著高于正常组(3．97±1．94比3．42±1．56,4．29±1．09比3．78±1．15,4．11±0．98比 3．53±1．23),IUGR组瘦素水平与BMI无显著相关性,而正常组瘦素与:BMI有一定的相关性。结论 IUGR儿瘦素水平的升高可能与瘦素抵抗或脂肪组织功能缺陷有关,瘦素作为生长促进因子参与生后个体的发育,是IUGR儿发生追赶生长的主要原因。     

足月新生儿脐血瘦素水平测定及其与胰岛素的关系

目的探讨瘦素对胎儿生长发育的影响及其与胰岛素的关系。方法采用放射免疫分析法对83例足月新生儿脐血瘦素、胰岛素水平进行测定,测量新生儿出生体质量、身长,记录性别及分娩方式,计算体质量指数(BMI)评估新生儿营养状况。结果1.足月新生儿脐血瘦素水平为(10.53±7.05)μg/L,其中男婴(9.01±4.53)μg/L;女婴(11.62±5.03)μg/L。剖宫产组瘦素水平(10.07±5.88)μg/L;阴道分娩组瘦素(13.55±12.00)μg/L。瘦素水平在性别之间无明显差异(t=1.934 P>0.05),分娩方式间亦无明显差异(t=-1.216 P>0.05)。2.新生儿脐血瘦素水平与BMI呈显著正相关(r=0.520 P<0.01)。瘦素水平在大于胎龄儿(LGA)、适于胎龄儿(AGA)、小于胎龄儿(SGA)组分别为(17.29±8.99)(、10.54±4.96)(、3.33±1.58)μg/L,3组间有明显差异,LGA组明显高于其他两组(F=16.5 P<0.01)。3.新生儿脐血瘦素水平与胰岛素呈显著正相关(r=0.436 P<0.01)。结论瘦素在胎儿宫内生长和发育过程中起重要的调节作用,与胰岛素关系密切。     

L-精氨酸对宫内发育迟缓胎鼠胰岛素样生长因子及其结合蛋白表达的影响

目的：宫内发育迟缓(IUGR)儿常有脑发育的异常,L精氨酸具有舒张血管、增加胎盘血流的作用,可用于改善胎盘缺氧状态,促进胎儿生长发育。用被动吸烟法制作孕鼠IUGR模型,孕8～20d给予不同剂量L精氨酸,了解其对宫内发育迟缓胎鼠脑内胰岛素样生长因子及其结合蛋白表达的影响,并探讨L精氨酸的作用机制。方法：孕鼠随机分为4组:对照组、模型组、L精氨酸小剂量和大剂量防治组,每组9只。孕21d剖宫取胎,应用酶联免疫吸附法检测各组胎鼠脑组织胰岛素样生长因子Ⅰ(IGFⅠ)、胰岛素样生长因子Ⅱ(IGFⅡ)、胰岛素样生长因子结合蛋白(IGFBP3)含量,应用荧光定量RTPCR法检测各组胎鼠脑组织IGFⅠmRNA表达。结果：与对照组相比较,模型组胎鼠脑组织中IGFⅠ(0.789±0.062ng/mgvs0.947±0.042ng/mg)、IGFⅡ(0.270±0.020ng/mgvs0.374±0.015ng/mg)含量均比对照组明显降低,IGFBP3(0.253±0.011ng/mgvs0.089±0.015ng/mg)含量比对照组明显升高,IGFⅠmRNA表达量(13.12±1.39)×104cps/μgRNAvs(21.28±3.54)×104cps/μgRNA比对照组明显降低,差异均有显著性(P<0.01)。与模型组相比较,小剂量和大剂量L精氨酸防治组IGFⅠ含量明显增高,分别为0.937±0.067ng/mg和0.858±0.077ng/mg,IGFⅡ含量明显增高,分别为0.318±0.018ng/mg和0.354±0.021ng/mg,IGFBP3含量明显降低,分别为0.132±0.006ng/mg和0.146±0.009ng/mg差异有显著性(P<0.01或<0.05)。同时小剂量和大剂量L精氨酸防治组IGFⅠmRNA表达量也明显增高,分别为(19.24±2.48)×104cps/μgRNA和(17.35±2.30)×104cps/μgRNAvs(13.12±1.39)×104cps/μgRNA,差异均有显著性(P<0.01)。结论：L精氨酸可增加被动吸烟致宫内发育迟缓胎鼠脑内IGFⅠ、IGFⅡ含量和IGFⅠmRNA的表达,降低IGFBP3含量。L精氨酸防治IUGR的机制与其对胰岛素样生长因子及其结合蛋白表达的影响有关。     

宫内生长迟缓儿胰岛素样生长因子及其结合蛋白水平的变化

宫内生长迟缓(IUGR)主要由母亲、胎儿、胎盘因素引起。有文献报道IUGR儿脐血胰岛素样生长因子(IGF)-1及其结合蛋白(IUBP)-3的水平是低的,而IGFBP-1的水平是高的。尽管大部分IUGR儿童有追赶生长,但仍有20%的IUGR儿童保持永久的矮小。持续性低IGF-1和高IGFBP-1可能是决定IUGR儿出生后追赶生长速度的主要原因。     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. CONCLUSION: In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.