足月小于胎龄儿胃饥饿素、胰岛素样生长因子-1及瘦素关系的研究

目的探讨胃饥饿素（Ghrelin）、胰岛素样生长因子-1（IGF-1）及瘦素（Leptin）在足月小于胎龄儿（SGA）中的作用及其关系。方法本院产科出生的足月SGA和适于胎龄儿（AGA）各30例,生后测量体重、身长、头围,并计算体重指数（BMI）,生后第3天测定血Ghrelin、IGF-1及Lep-tin水平。结果 SGA组体重、身长、头围、BMI均明显低于AGA组[（2280±190）g比（3220±320）g,（46.3±1.8）cm比（50.5±2.0）cm,（31.8±1.1）cm比（33.6±1.1）cm,（10.6±0.8）cm比（12.6±0.9）cm,P均〈0.05]。SGA组血清IGF-1及Leptin水平均低于AGA组[（49.6±10.3）μg/L比（55.3±9.9）μg/L,（2.4±0.8）μg/L比（3.0±1.0）μg/L],血浆Ghrelin水平高于AGA组[（25.2±11.0）μg/L比（17.3±7.4）μg/L],P均〈0.05。两组IGF-1与体重呈正相关,Leptin与体重、身长呈正相关,Ghrelin与体重、BMI呈负相关,P均〈0.05。两组Ghrelin水平与IGF-1呈负相关,IGF-1与Leptin呈正相关;SGA组Ghrelin水平与Leptin呈负相关,P均〈0.05。结论生后早期SGA新生儿存在高Ghrelin、低IGF-1、低Leptin水平状态。Ghrelin、IGF-1及Leptin共同参与胎儿宫内营养的调节,相互起协同及拮抗作用。     

儿童急性淋巴细胞白血病血清IGF-1和IGFBP-3表达变化及其意义

目的：探讨急性淋巴细胞白血病（ALL）患儿血清中胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白-3（IGFBP-3）水平的表达变化及其临床意义。 方法：36例ALL患儿分别在治疗前和完全缓解后6个月留取血清, 对照组血清来自30例外科疾病患儿。应用放射免疫法（RIA）测定IGF-1和免疫放射法（IRMA）测定IGFBP-3水平。结果：ALL组治疗前血清IGF-1、IGFBP-3水平分别为19±4 ng/mL和1216±132 ng/mL,低于对照组的IGF-1、IGFBP-3水平（分别为32±3 ng/mL、2104±191 ng/mL）, 差异有统计学意义（P0.05）。结论：ALL患儿血清IGF-1和IGFBP-3水平降低,并随着病情缓解而升高。提示IGF-1和IGFBP-3可能可以作为儿童ALL诊断及疗效判断的有效指标。     

早产儿血清瘦素及多种生长相关激素水平研究

目的 瘦素(leptin,LEP)主要由脂肪组织产生,参与机体能量代谢、调节生长发育.本研究通过检测早产儿不同日龄(第1、7、12天)的体重指数(body mass index,BMI)、头围(headcircumference,HC)及血清LEP、神经肽Y(neuropeptide Y,NPY)、胰岛素(insulin,INS)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平,探讨早产儿血清LEP及多种生长相关激素水平变化与体重变化的关系.方法 70例早产儿中患严重疾病的早产儿40例(患病组)、未患严重疾病的早产儿30例(对照组),测最出生第1、7、12天时体重、身长、头围,计算BMI,应用放射免疫分析法检测相应日龄血清LEP、NPY、INS、IGF-1水平.结果 (1)患病组早产儿生后第1、7、12天血清LEP分别为0.74±21、0.60±0.18、0.82±0.12(mg/L)(P<0.01),BMI分别为9.81±1.24、8.36±0.87、9.08±1.12(kg/m2)(P<0.01);对照组早产儿生后第1、7、12天血清LEP分别为0.78±0.17、0.71±0.17、0.88±0.58(mg/L)(P<0.01),BMI分别为10.03±1.04、9.35±0.80、11.06±0.82(kg/m2)(P<0.01).两组早产儿血清LEP水平,第1天差异无统计学意义(P>0.05),第7、12天患病组均低于对照组(P<0.01).(2)患病组及对照组早产儿不同日龄血清LEP与BMI均存在正相关关系.(3)患病组早产儿生后第1、7、12天血清NPY水平,分别为55.33±9.38、46.64±6.17、75.13±9.12(ng/L)(P<0.01),血清INS水平分别为10.07±2.63、7.71±2.77、10.37±2.29(mU/L)(P<0.01),血清IGF-1水平分别为38.66±11.42、31.98±7.34、41.84±8.05(mg/L)(P<0.01).对照组早产儿在生后第1、7、12天血清NPY水平,分别为57.77±7.15、48.49±8.81、81.36±8.51(ng/L)(P<0.01),血清INS分别为11.55±1.99、8.28±2.87、15.42±3.80(mU/L)(P<0.01),血清IGF-1水平,分别为37.76±7.07、34.33±8.97、50.19±8.38(mg/L)(P<0.01).患病组及对照组早产儿生后第1、7、12天血清LEP水平及BMI与相应日龄血清NPY、INS、IGF-1水平,分别存在正相关关系.结论 (1)随着早产儿出生早期BMI、HC先下降冉回升的变化趋势,血清LEP水平也有相应的变化,提示LEP与早产儿出生早期的体重变化有关系.(2)患严重疾病早产儿血清LEP水平明显下降.(3)LEP可能与NPY、INS、IGF-1之间相互关联,共同影响早产儿体重变化.     

足月小于胎龄儿胃饥饿素、胰岛素样生长因子-1及瘦素关系的研究

目的探讨胃饥饿素(Ghrelin)、胰岛素样生长因子-1(IGF-1)及瘦素(Leptin)在足月小于胎龄儿(SGA)中的作用及其关系。方法本院产科出生的足月SGA和适于胎龄儿(AGA)各30例,生后测量体重、身长、头围,并计算体重指数(BMI),生后第3天测定血Ghrelin、IGF-1及Lep-tin水平。结果 SGA组体重、身长、头围、BMI均明显低于AGA组[(2280±190)g比(3220±320)g,(46.3±1.8)cm比(50.5±2.0)cm,(31.8±1.1)cm比(33.6±1.1)cm,(10.6±0.8)cm比(12.6±0.9)cm,P均<0.05]。SGA组血清IGF-1及Leptin水平均低于AGA组[(49.6±10.3)μg/L比(55.3±9.9)μg/L,(2.4±0.8)μg/L比(3.0±1.0)μg/L],血浆Ghrelin水平高于AGA组[(25.2±11.0)μg/L比(17.3±7.4)μg/L],P均<0.05。两组IGF-1与体重呈正相关,Leptin与体重、身长呈正相关,Ghrelin与体重、BMI呈负相关,P均<0.05。两组Ghrelin水平与IGF-1呈负相关,IGF-1与Leptin呈正相关;SGA组Ghrelin水平与Leptin呈负相关,P均<0.05。结论生后早期SGA新生儿存在高Ghrelin、低IGF-1、低Leptin水平状态。Ghrelin、IGF-1及Leptin共同参与胎儿宫内营养的调节,相互起协同及拮抗作用。     

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]     

血清胰岛素样生长因子Ⅰ及生长激素与新生儿缺氧缺血性脑病的关系

目的：研究新生儿缺氧缺血性脑病（HIE）血清胰岛素样生长因子Ⅰ（IGF-Ⅰ）和生长激素（GH）水平, 探讨血清IGF-Ⅰ,GH与HIE严重程度之间的关系。方法：测定实验组53例HIE新生儿（其中轻度30例、中度15例、重度8例）生后72 h内、26～28 d血清IGF-Ⅰ和GH水平,以30例正常新生儿作对照;HIE组新生儿分别在急性期和恢复期做新生儿神经行为测定（NBNA）,分析血清IGF-Ⅰ和GH与HIE严重程度及与NBNA之间的关系。结果：轻、中、重度 HIE新生儿血清 IGF-Ⅰ 水平在生后72 h内分别为59.65±29.61 ng/mL、33.56±17.32 ng/mL、23.58±13.57 ng/mL,生后26～28 d分别为89.26±48.65 ng/mL、71.46±38.35 ng/mL、54.39±26.39 ng/mL。对照组在72 h及26~28 d时,IGF 1水平为71.23±35.42 ng/mL、96.54±52.38 ng/mL,与实验组比较均P<0.01。病情越重血清IGF-Ⅰ水平越低（P＜0.05)。血清GH水平与HIE的严重程度无相关性。HIE组血清IGF-Ⅰ水平在急性期和恢复期均与NBNA高度相关（r=0.295, P＜0.05; r=0.263,P＜0.05）,而GH无论在急性期和恢复期均与NBNA分值没有相关性。结论：测定新生儿HIE血清IGF-Ⅰ水平可判断HIE的严重程度,血清IGF-Ⅰ水平可能影响HIE新生儿的预后。［中国当代儿科杂志,2007,9（1）：22-24］     

早产适于胎龄儿婴儿期追赶生长特点和2至3岁生长偏离的队列研究

目的 分析早产适于胎龄儿婴儿期追赶生长特点和2～3岁生长偏离情况。 方法 以队列研究设计实验方案。选择成都市妇女儿童中心医院（我院）出生的无明显疾病状态的早产儿,生后行单纯早产儿出院后配方粉喂养至达到WHO儿童生长发育标准身长别体重的P50水平后,转换为足月儿配方粉喂养至12月龄; 9月龄前每月和12月龄行体格测量和喂养指导。随访至2～3岁并行体格测量,与2006年 WHO（简称WHO）和2005年中国九市城区（简称中国九市城区）标准的足月儿增长 值比较。 结果 符合本文纳入标准早产儿165例,达到WHO儿童生长发育标准P50水平后转换为任意品牌足月儿配方粉喂养,并于2～3岁均来我院随访,其中122例早产儿规律地完成了1~9月龄和12月龄的体格测量和喂养指导,43例未规律随访和接受喂养指导。早产儿男婴体重和身长与WHO标准差异有统计学意义,与中国九市城区标准头围差异有统计学意义。早产儿女婴体重与WHO标准差异有统计学意义。早产儿女婴头围与中国九市城区标准差异有统计学意义。早产儿男女婴儿各月龄体重、身长和头围的增长值差异无统计学意义。早产儿男女婴儿每月体重、身长和头围增长不符合足月儿生长规律。规律随访的婴儿至2～3岁均无生长偏离,未规律随访和接受喂养指导的婴儿至2～3岁,基于WHO标准出现生长偏离为54%（23/43）, 基于中国九市城区标准出现生长偏离为98%（42/43）,均以超重危险和超重为主。 结论 早产儿的追赶生长不遵从足月儿规律,早产儿追赶生长现象贯穿于0~12月龄,婴儿期个体化喂养指导是幼儿期生长偏离的影响因素。与WHO标准相比采用中国九市城区BMI标准将升高超重危险和超重儿童的筛出率。     

早产儿血清IGF-1水平与喂养困难的相关性研究

目的探究早产儿血清胰岛素样生长因子-1(IGF-1)水平与喂养困难的相关性。方法回顾性分析2013年1月至2014年1月出生的200例早产儿病历资料,分析IGF-1与早产儿喂养困难的相关性。结果喂养困难组IGF-1水平(28±4 ng/m L)明显低于对照组(63±8 ng/m L),差异有统计学意义(P0.05)。多因素logistic回归分析显示胎龄大、出生体重大为早产儿喂养困难的保护性因素;窒息、开奶延迟、使用氨茶碱、围生期感染、低IGF-1水平为早产儿喂养困难的危险因素。结论早产儿血清IGF-1水平与喂养困难相关,其水平降低发生喂养困难的风险增大。     

早产儿和足月新生儿血清中地高辛样免疫活性物质

本文报告了不同胎龄和出生体重的健康新生儿血清中地高辛样免疫活性物质(DLIS)的检出,且随日龄增长而消失。材料和方法第1组为50名健康足月儿,平均胎龄39.7周,平均体重3365克;第2组为19名早产儿,平均胎龄33周,平均体重1965克。上述两组胎龄与体重相符合。第3组是13名足月小样儿(SGA),体重低于第10百分位,平均胎龄38.5周,平均体重2075克。三组全部经产道分娩,Apgar评分≥7。母亲在妊娠期末用过毛地黄。第1组的标本采自出生时脐血。第2、3组标本采自生后第1、7、14和21天的毛细血管,用放射免疫法(RIA)检测,此法地高辛检出的最低浓度为0.5ng/ml。结果50名足月新生儿,32例(64%)DLIS≥0.5ng/ml,其中2例高达1.0ng/ml。19名早产儿中     

低出生体重儿肾上腺皮质功能的研究

目的 探讨低出生体重儿生后肾上腺皮质功能的变化及临床意义。方法 应用放免的方法对110名低出生体重儿生后1、7、14、21天血清皮质醇水平检测，并与30名足月儿生后相同时段皮质醇水平进行对照。结果 低出生体重儿生后血清皮质醇水平均呈不同程度的下降趋势：足月小样儿、大胎龄早产儿于生后1周达稳态，小胎龄早产儿于生后2周达稳态，达稳态时均与同日龄足月儿水平均值相比差异无显著性。结论 低出生体重儿生后因宫内外环境的变化而产生应激反应使血清皮质醇处于高水平，随生后日龄增加对宫外环境的适应，应激反应减轻，其血清皮质醇水平逐渐下降，最迟于生后2周达稳态，与足月儿水平相比差异无显著性。     

Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term

Background

We aimed to analyze the effect of oral zinc supplementation on serum insulin-like growth factor-1 (IGF-1) levels and catch-up growth in infants with non-organic failure to thrive (NOFTT) who were born preterm as compared to those born at term.

Effect of insulinlike growth factor-1 treatment in children with cystic fibrosis.

OBJECTIVES: Malnutrition is common in cystic fibrosis (CF) and adversely affects survival. Because insulinlike growth factor-1 (IGF-1) has insulinlike effects in terms of carbohydrate metabolism and is growth promoting, the authors hypothesized that its use would increase linear growth rate and decrease insulin requirements in children with CF. METHODS: The authors used a double-blind placebo-controlled crossover design. Seven prepubertal children aged 9.6 to 13 years (5 boys and 2 girls) were treated with placebo or IGF-1 for 6 months. After a 6-month washout period, patients received the alternative therapy for 6 months. The primary outcome measure was linear growth rate. Secondary outcome measures were changes in body mass index, body composition determined by dual energy x-ray absorptiometry, forced expiratory volume (FEV(1)), and the blood glucose/insulin ratio. RESULTS: The mean height z score at baseline was -1.5 +/- 0.8. At entry, the mean serum IGF-1 level was 124 +/- 25 ng/mL (normal range, 110-771 ng/mL). With treatment, mean serum IGF-1 levels increased twofold to threefold for all patients. The half-life for IGF-1 was 10.3 hours. We observed no significant difference in linear growth rate, weight gain, rate of accretion of lean body mass, or mean FEV(1) during treatment with IGF-1 compared with placebo. The glucose/insulin ratio, an indirect index of insulin sensitivity, was significantly increased with IGF-1 treatment compared with placebo ( P < 0.02). No adverse events related to IGF-1 were detected. CONCLUSIONS: Treatment with IGF-1 for 6 months did not promote linear growth in prepubertal children with CF. However, the glucose/insulin ratio was increased without changing blood glucose levels with IGF-1 treatment suggesting increased insulin sensitivity.     

早产儿血清维生素E浓度测定

目的　测定早产儿维生素E的二种异构体α 生育酚和γ 生育酚的血清浓度,探讨早产儿体内维 生素E的水平。方法　选取早产儿、正常足月儿各16例,采用库仑阵列电化学法检测血清中维生素E水平。结果 与正常足月儿对比,早产儿血清α 生育酚浓度(217±120ng/mLvs411±284ng/mL)和γ 生育酚浓度(889±460 ng/mLvs2177±1031ng/mL)明显降低,差异有显著性意义(均P<0.05)。结论　早产儿体内维生素E储藏量相 对较少,容易发生维生素E缺乏。早产儿出生后应及时补充维生素E。     

The influence of gestation and mechanical ventilation on serum clara cell secretory protein (CC10) concentrations in ventilated and nonventilated newborn infants

Clara cell secretory protein (CC10) is an important anti-inflammatory mediator in the adult lung, but its role in newborn pulmonary protection is uncertain. We examined the early postnatal behavior of CC10 in newborn serum and tracheal fluid and hypothesized that CC10 production is positively influenced by gestation. Blood from 165 infants from the first, third/fourth, and seventh days of life (gestational ages: 23-29 wk, 30-36 wk, >36 wk) and tracheal fluid (TF) from the first day of life from 32 ventilated infants were analyzed for CC10. Surfactant proteins A (SPA) and B (SPB) were also analyzed from the blood of a subgroup of infants. Serum CC10 on day 1 was highest in term infants (69.4 ng/mL), followed by moderately preterm (55.8 ng/mL), and then extremely preterm infants (median 42.1 ng/mL). Term infants also had higher tracheal fluid CC10 than preterm infants. (20.152 ng/mL versus 882 ng/mL). Mechanical ventilation increased serum CC10 only in moderately preterm infants, and only on d 1 [68.4 ng/mL versus 42.1 ng/mL (nonventilated moderately preterm infants)]. Serum CC10 decreased progressively by the end of the first week in all infants, in contrast to SPA and SPB, which increased. Our results show that CC10 is detectable in the blood of newborn infants and that a production surge occurs at birth. This surge is more pronounced in term infants and may confer them with superior extrauterine pulmonary protection compared with preterm infants.     

Physical growth and retinopathy in preterm infants: involvement of IGF-I and GH.

GH and IGF-I are important for physical growth. We measured serum levels of these factors in preterm infants. The study population (n = 81) was divided into three groups according to the gestational age. We evaluated differences in serum GH and IGF-I levels among groups with regard to physical growth and development of retinopathy of prematurity. Serum GH levels in extremely preterm infants born at <28 wk of gestational age were significantly higher than levels in those born between 28 and 34 wk at 1 and 2 mo of age. In contrast, serum IGF-I levels in extremely preterm infants remained low, whereas those in the other two groups gradually increased. Evaluation of the effects of GH and IGF-I on physical growth in very low birth weight infants (<1500 g) showed that IGF-I concentrations were positively related to physical growth for several months after birth, whereas no relationship was observed between GH and physical growth. Multivariate analysis demonstrated that high GH concentration at 1 mo of age was significantly associated with development of severe retinopathy of prematurity. In conclusion, persistent low serum IGF-I levels may explain the slow physical growth during neonatal life, and exposure of high GH may cause, at least in part, severe retinopathy of prematurity in preterm infants.     

早产儿胃食管反流与表皮生长因子和胰岛素样生长因子-I关系的探讨

目的观察早产儿胃食管反流(GER)血清中胰岛素样生长因子I(IGF-I)以及血清和胃液中表皮生长因子(EGF)的水平变化,探讨IGF-I及EGF对新生儿胃肠运动功能的影响。方法用24h食管pH监测仪测定46例早产儿,15例无GER早产儿作为对照组,放免法测定血清IGF-I、EGF及胃液EGF的含量。结果不同程度GER患儿IGF-I水平与正常对照组比较均无明显差异(P>0.05),中重度胃食管反流早产儿血清、胃液EGF水平较正常对照组显著下降(P<0.01)。结论早产儿GER发生的程度与EGF含量有关,IGF-I水平与GER发生无关。EGF作为一种胃肠激素,对早产儿胃肠运动功能有明显影响。     

Postnatal growth failure in preterm infants: recovery of growth and body composition after term

BACKGROUND: Many preterm infants are significantly growth restricted at hospital discharge and are at increased risk for long-term growth failure. AIMS: To compare growth and weight gain composition after term between preterm infants who were growth retarded and those who were not. STUDY DESIGN: An observational longitudinal study was conducted. SUBJECTS: 35 preterm infants who showed growth retardation at term (group 1) and 26 preterm infants who did not (group 2). OUTCOME MEASURES: Growth and body composition were assessed at term and at 1, 2, 3, 4 and 5 months of corrected age. RESULTS: At term, and at 1, 2, and 3 months of corrected age, growth-retarded infants showed significantly lower body weight and fat mass than infants who did not develop growth retardation. The mean energy and protein intakes did not differ significantly between the two groups. Daily increases in body weight and fat mass between term and three months did not differ between the groups. However, during the fourth and fifth months, daily gains of body weight and fat mass were significantly greater in growth-retarded than in non-growth-retarded infants, and as a result, body weight and fat mass were comparable between the two groups at 4 and 5 months of corrected age. CONCLUSIONS: In terms of growth parameters and body composition, growth-retarded preterm infants recovered from postnatal growth failure within the fourth month of corrected age.     

Longitudinal growth of body weight and crown heel length in Punjabi infants: population comparison

One hundred and fifty four Punjabi infants (86 males and 68 females) were longitudinally studied for body weight and crowh-heel length at monthly age intervals at Nehru Hospital, P.G.I.M.E.R., Chandigarh. In general male infants were found to be heavier and longer than their female counterparts throughout infancy. Sex differences were found to be statistically significant at most of the age levels (P<0·05). Patternwise similarity in growth of body weight and crown-heel length was noticed between Punjabi and Western infants upto first six months. Thereafter, dampening in distance curves of Punjabi infants was noticed in contrast to those of Western origin. Punjabi infants showed better growth as compared to those studied in other parts of India. This could be related to better economic and living conditions. Crown-heel length velocity showed a sharp decline in the rate immediately after birth upto four months, after which flattening of curves was observed. In contrast to crown heel length body weight has shown an initial acceleration in growth rate between birth and two months with a peak at 1·5 months. Thereafter a sharp decline in growth velocity was noticed upto six months. Sex differences in monthly growth rates were found, to be statistically insignificant throughout infancy (P<0·05). An erratum to this article is available at .     

Growth hormone levels in relation to birth weight and gestational age

Growth hormone levels were measured in 33 umbilical cord blood samples collected from babies born at JIPMER Hospital during April and May-1998. The study was done to evaluate the growth hormone profile in relation to birth weight and gestational age. There was statistically significant difference in the cord blood growth hormone levels between babies weighing > 2500 gms (28.1 ± 12.83 ng/dl) and low birth weight babies (76.8 ± 55.7 ng/dl). The difference in growth hormone levels between term babies weighing >2500 gms and preterm babies (72.5 ± 29.4 ng/dl) was also statistically significant. However, there was no significant difference in the cord blood growth hormone levels between term low birth weight and preterm babies. Growth hormone levels were higher in preterm babies and low birth weight babies as compared to term babies weighing >2500 gms indicating that growth hormone has an important role to play in intrauterine growth along with other growth promoting factors.