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目的 通过比较小于胎龄儿(SGA)和足月正常新生儿脐血Ghrelin水平的变化,分析脐血Ghrelin与新生儿出生体重、身长、头围、BMI和胎盘重量、胎盘体积的关系,以及脐血Ghrelin水平与IGF-1、胰岛素、胰岛素敏感性和血糖的关系.探讨脐血Ghrelin水平与胎儿发育和代谢轴之间,尤其是Ghrelin与IGF-1的相互关系.方法 2006年12月至2007年3月选择中山大学附属一院新生儿78例,SGA组22例为观察组,足月适于胎龄儿(AGA)42例为正常对照组.采用酶联免疫反应法(ELISA)对新生儿脐血Ghrelin、胰岛素、IGF-1进行测定分析,测量新生儿净体重、身长、头围、胎盘体积、胎盘重量,计算体重指数(BMI)和胰岛素敏感指数(ISI).结果 (1)SGA组脐血Ghrelin水平(38.74±4.90 ng/mL)明显高于正常对照组(23.37±8.78 ng/mL),其差异有统计学意义(P＜0.05).(2)脐血Ghrelin水平与新生儿出生体重、身长、头围、BMI、胎盘重量、胎盘体积呈负相关,均有统计学意义(P＜0.05).(3)脐血Ghrelin水平与IGF-1、胰岛素、ISI呈负相关均有统计学意义(P＜0.05).与血糖无相关性(r=0.081,P=0.454).(4)通过偏相关分析,控制出生体重、身长、胎盘重量、BMI、胰岛素后,Ghrelin与IGF-1有明显负相关性,有统计学意义.(5)剖宫产新生儿脐血Ghrelin水平与顺产儿无明显差异(P=0.956);男性与女性新生儿脐血Ghrelin水平无明显差异(P=0.385).结论 新生儿脐血Ghrelin水平是反映胎儿的宫内发育及营养状态的指标之一.并以负反馈形式参与胎儿宫内发育和代谢轴的调控过程.小于胎龄儿出生时可能存在胰岛素抵抗.小于胎龄儿高Ghrelin并没有刺激胰岛素释放,提示小于胎龄儿可能存在Ghrelin受体或受体后信号传导通路的抵抗.

Study on the relationship between ghrelin level in cord blood of small for gestational age with the intrauterine fetal growth and metabolism axis

??Objective Objective of this study is to compare the Ghrelin concentration in the umbilical cord blood of SGA and normal control group,and analyze the relationship between Ghrelin concentration in the umbilical cord ghrelin with the following indexes: birth weight,birth length,head circumference,BMI placenta weight and placenta volume,and with IGF??1,insulin,insulin sensitivity index and glucose.By approaching the interrelationship and effect between the Ghrelin concentration in the umbilical cord with fetal growth and metabolism axis,especially the relationship with IGF??1.Methods 78 neonates were enrolled in this study.There were 22 cases of SGA were enrolled in analyzed,42 case of full term AGA were enrolled in normal control group.The concentration of Ghrelin,Insulin and IGF??1 was measured by ELISA assays.The birth weight and length,head circumference,the weight of placenta and the volume of placenta were measured.BMI and ISI were then calculated out.Results 1.Ghrelin concentration in the umbilical cord blood of SGA was significantly higher than that detected in normal control group (??P??<0.05).2.Ghrelin concentration in the umbilical cord blood of neonates is negatively correlated with birth weight,birth length,head circumference,BMI placenta weight and placenta volume,There are statistical significance(??P<0.05).3.Ghrelin concentration in the umbilical cord blood of neonates is negatively correlated with IGF??1,insulin,ISI,There are statistical significance(P<0.05).It is not correlated with glucose(??r??=0.081,??P??=0.454).4.According partial correlation analysis,controlling birth weight,birth length,placenta weight,BMI and insulin,Ghrelin concentration in the umbilical cord blood of neonates is negatively correlated with IGF??1??5.There was not significant difference in Ghrelin level between cesarean??delivered and spontaneous??delivered neonates(P=0.956).so as the Ghrelin level between male and female neonates (??P??=0.385).Conclusion Ghrelin can reflect the intrauterine fetal development and nutrition statue and take part in the regulation of intrauterine fetal growth and metabolism by negative feedback.The insulin resistance maybe exists in SGA.The high concentration of Ghrelin did not stimulate the release of insulin also indicated the possibility of Ghrelin resistance of GHS??R or conduction path of postamble receptor.