小于胎龄儿胎盘11β-HSD2及脐血皮质醇的研究

目的检测小于胎龄儿(SGA)的胎盘11-β羟基类固醇脱氢酶2型及脐血皮质醇水平,初步探讨足月小于胎龄儿的发生机制。方法足月SGA新生儿20例(其中母亲正常妊娠的SGA新生儿10例为SGA1组,母亲有妊高症、或羊水少、或胆汁淤积症妊娠的SGA新生儿10例为SGA2组),正常妊娠的足月AGA新生儿10例为对照组。采用RT-PCR法检测人胎盘组织11β-HSD2基因mRNA的表达水平,采用化学发光法检测脐血皮质醇浓度。结果 1)胎盘11β-HSD2mRNA的表达水平与新生儿出生体重具有显著正相关(r=0.554,P<0.01);2)SGA组11β-HSD2 mRNA表达水平显著低于对照组(0.054±0.016 vs 0.082±0.026);SGA1组与SGA2组胎盘11β-HSD2 mRNA表达水平无差异;3)SGA组脐血皮质醇含量显著低于对照组(169.05±83.77nmol/l vs 327.90±179.19)nmol/l,P<0.05;SGA1组与SGA2组脐血皮质醇含量有差异。结论足月小样儿的发生与胎盘11β-HSD2活性下降有关,足月小样儿妊娠晚期脐血皮质醇浓度较适于胎龄儿低,与胎盘11β-HSD2的活性无关,可能主要与小于胎龄儿的HPA轴未成熟有关。     

小于胎龄儿脐血脂联素水平测定及其临床意义

目的探讨小于胎龄儿（SGA）脐血脂联素（APN）水平变化及其对新生儿的影响。方法研究对象为SGA和适于胎龄儿（AGA）各30例。采用放射免疫分析法测定脐血和产妇血脂联素水平。用免疫比浊法测定三酰甘油（TG）,总胆固醇（TCH）,低密度脂蛋白胆固醇（LDL-C）,高密度脂蛋白胆固醇（HDL-c）水平。并分析脐血脂联素水平与母血脂联素,体质量指数（IBM）,胎盘重量和血脂水平的相关性。结果1.SGA脐血脂联素水平低于AGA差异有显著性（P〈0.01）;SGA血TG,TCH,LDL-c,HDL-c水平与AGA比较差异均无显著性（P〉0.05）。2.SGA血清脂联素水平与新生儿身长,新生儿体质量指数BMI,胎盘重量,脐血TG呈显著正相关（r=0.386,0.431,0.365,0.231,P〈0.05）,与母血脂联素水平,孕前和分娩时产妇IBM无相关性（P〉0.05）。结论小于胎龄儿具有较低血清脂联素水平,测定脐血脂联素水平有助于判断SGA的发展趋势。     

早产适于胎龄儿营养状况分析

目的 对我院早产儿住院期间的营养状况进行分析，以期对将来早产儿的营养支持策略有一定的指导作用。方法 回顾性分析2000年～2006年我院出生的375例早产儿住院期间的临床资料，包括出生体重、胎龄、性别、喂养方法、住院时间、恢复至出生体重的时间、合并症情况、出院时体重及出院时纠正胎龄等。结果 出院时小于胎龄儿（SGA）占28．53％；出生体重及胎龄对早产儿早期的营养状况有影响，出院时SGA组其出生体重及胎龄明显小于适于胎龄组（AGA），差异有统计学意义（P〈0．05=；AGA组早产儿其住院时间、生理性体重下降的时间明显缩短，合并症的发生也明显减少，差异均有显著性（P〈0．05=。结论 早期营养干预对早产儿的生存有重要意义，要重视早期的营养支持，使其发育达到与宫内相仿。     

母血及脐血中抵抗素水平与胎儿出生体重关系的研究

目的探讨母血及脐血抵抗素水平与胎儿出生体重的关系。方法采用酶联免疫吸附法检测14例分娩正常出生体重儿组（AGA组）、14例高出生体重儿组（LGA组）及14例低出生体重儿组（SGA组）母血及脐血血清抵抗素水平。结果（1）AGA组、LGA组、SGA组母血抵抗素水平分别为10.51±1.64、9.26±1.28、12.77±2.90μg/L,脐血抵抗素水平分别为20.43±1.78、18.63±1.70、24.41±4.80μg/L;（2）LGA组与AGA组比较,母血与脐血抵抗素水平的差异均有显著性（均P〈0.05）,SGA组与AGA组比较,母血与脐血抵抗素水平的差异也均有显著性（均P〈0.05）;（3）脐血与母血抵抗素水平成正相关（r=0.869,P〈0.05）;（4）母血与脐血抵抗素水平与胎儿出生体重均成负相关（r=-0.662,P〈0.05：r=-0.678,P〈0.05）。结论抵抗素水平的变化可能在胎儿出生体重的调节中起重要作用。     

宫内生长迟缓新生儿脐血瘦素及甘油三酯变化的研究

目的观察宫内生长迟缓(IUGR)新生儿脐血中的瘦素(leptin)、甘油三酯(TG)水平,分析这些指标变化程度与胎儿生长的关系,探讨IUGR新生儿血脂代谢的特点.方法 77例新生儿脐血标本分为3组:(1)小于胎龄儿组( SGA):17例;(2)适于胎龄儿( AGA)组:41例;(3)大于胎龄儿( LGA)组:19例.采用高敏酶免疫分析法测定新生儿脐血中瘦素水平,全自动生化分析仪测定TG水平.各组间均数比较选用单因素方差分析,各指标与出生体重及胎龄的关系采用等级相关分析.结果 (1)脐血瘦素水平AGA、SGA、LGA 3组差异有统计学意义(F=17.75,P<0.01);SGA组(0.7147±0.5761)ng/ml显著低于AGA组(2.710±0.4329)ng/ml(P<0.01),而AGA组低于LGA组(5.687±0.3916)ng/ml(P<0.05).脐血瘦素水平随胎龄及出生体重增加而增加(r分别=0.332和0.654,P均<0.01).(2)脐血TG水平AGA、SGA、LGA 3组差异有统计学意义(F=8.85,P＜0.05);SGA组(0.7141±0.1576)mmol/l显著高于AGA组(0.5027±0.1330)mmol/l(P<0.01), 而AGA组与LGA组(0.4907±0.1397)mmol/L之间差异无统计学意义(P>0.05).TG与出生体重呈负相关(r=-0.320,P=0.050),与胎龄无相关性(r=0.129,P>0.05). (3)脐血瘦素与TG呈负相关关系(r=-0.280,P<0.05).结论 IUGR新生儿脐血瘦素明显降低,瘦素与胎龄及出生体重呈正相关.IUGR新生儿脐血TG偏高,TG与出生体重负相关,与胎龄无相关性.脐血瘦素与TG呈负相关.     

小于胎龄儿追赶生长特点及影响因素分析

目的探讨中国北方地区小于胎龄儿(SGA)出生后追赶生长特点以及相关影响因素。方法以2012年1月至2013年1月在河北省廊坊市妇幼保健中心出生的新生儿为研究对象,根据出生体质量分为SGA组、适于胎龄儿组(AGA)和大于胎龄儿组(LGA),收集出生时至2岁资料。统计分析SGA出生后追赶生长特点以及相关影响因素。结果研究共纳入SGA、AGA和LGA分别661例(8.3%)、6571例(82.5%)和729例(9.2%)。SGA组2岁时矮小的比例为0.9%,高于AGA组(0.6%)和LGA组(0.3%)(P0.05)。SGA组出生后2年内追赶生长主要出现在1岁以内。相关性分析显示,SGA 1岁内身长增长速度与出生体质量、身长、Apgar评分呈负相关;与胎盘质量呈正相关,而与F/P呈负相关;与喂养方式相关。结论大部分SGA儿童在2岁时完成追赶生长,追赶生长主要出现在出生后1年内,胎盘不适当过重、喂养方式等因素均与SGA追赶生长相关。     

促酰化蛋白水平与胎儿生长发育的关系研究

目的探讨脐血促酰化蛋白（ASP）水平与胎儿生长发育的关系。方法研究对象为大于胎龄儿（LGA）、适于胎龄儿（AGA）和小于胎龄儿（SGA）各30例。应用ELISA法测定血清和羊水ASP浓度、血清脂联素浓度,RIA法测定血清胰岛素和瘦素水平,用免疫比浊法测定血脂水平;并分析脐血ASP水平与母血和羊水ASP水平、胎盘重量、新生儿身长、性别、体质量、BMI、腰围、腰臀比、血脂、胰岛素、瘦素和脂联素水平,孕妇的体质量和BMI、血脂水平的相关性。结果①LGA的脐血ASP水平高于AGA,AGA的脐血ASP水平高于SGA,差异有统计学意义（P〈0.001）;三组新生儿血脂水平差异无统计学意义（P〉0.05）。②脐血ASP水平与新生儿出生体质量、身长、BMI、腰围、腰臀比、胰岛素、瘦素、脐血甘油三酯水平呈显著正相关（P〈0.001）,与血脂联素水平呈显著负相关（P〈0.001）,与母血和羊水ASP水平、胎盘重量无相关性（P〉0.05）。③男、女婴脐血ASP、血脂各成分水平比较差异均无统计学意义（P〉0.05）。结论促酰化蛋白参与胎儿生长发育调节,脐血ASP水平可反映胎儿的生长发育状况。     

脐血中胰岛素、胰岛素样生长因子-I及胰岛素样生长因子结合蛋白-2与胎儿生长受限的关系

目的探讨脐血中胰岛素、胰岛素样生长因子-I及胰岛素样生长因子结合蛋白-2的水平与胎儿生长受限的关系及意义。方法收集2011年7月～2013年5月在本院分娩的单胎足月正常妊娠（无产科并发症）孕妇及其新生儿各120例,根据出生体重将新生儿分为小于胎龄儿（SGA）组、适于胎龄儿（AGA）2组。胎儿娩出后即抽脐静脉血5ml,标本收集后用高效液相色谱法测定脐血中胰岛素、胰岛素样生长因子-I及胰岛素样生长因子结合蛋白-2的水平。结果SGA组脐带血清胰岛素、胰岛素样生长因子-I水平明显低于AGA组,差异均有统计学意义（P〈0.01）;SGA组脐血胰岛素样生长因子结合蛋白-2水平明显高于AGA、组,差异有统计学意义（P〈0.01）;脐血中胰岛素样生长因子-I与胰岛素水平呈正相关关系,而与胰岛素样生长因子结合蛋白-2呈负相关关系;脐血胰岛素、胰岛素样生长因子-I水平与新生儿出生体重呈正相关关系,而胰岛素样生长因子结合蛋白2与之呈负相关关系。结论脐血胰岛素、胰岛素样生长因子-I、胰岛素样生长因子结合蛋白2与胎儿生长受限的发生密切相关。     

有生长追赶SGA大鼠促生长素轴的改变

目的: 研究青春前期有生长追赶的小于胎龄(SGA)大鼠促生长素轴的改变,探讨SGA个体生长追赶可能的发生机制。方法: 应用孕鼠全程饮食限制法制备SGA大鼠模型,测定4周龄子鼠尿生长激素(GH)排泄率、血胰岛素样生长因子-1(IGF-1)浓度、肝脏组织IGF-1 mRNA表达和胫骨生长板IGF-1、胰岛素样生长因子-1受体(IGF-1R)表达。结果: 有生长追赶SGA(CUG-SGA)大鼠尿GH水平显著高于无生长追赶SGA(NCUG-SGA)和适于胎龄(AGA)大鼠(P<0.05,P<0.01);血IGF-1水平CUG-SGA显著高于NCUG-SGA组(P<0.01),与AGA组无显著差异。CUG-SGA组肝脏IGF-1 mRNA表达较NCUG-SGA显著增高(P<0.01),与AGA相比无显著差异。胫骨生长板形态学的改变:SGA鼠生长板增殖区每柱细胞数较少,各期软骨细胞排列不规则。 NCUG-SGA组生长板总厚度、各区厚度均较CUG-SGA和AGA组显著降低;CUG-SGA组生长板厚度与AGA组比较无显著差异,但肥大区厚度较NCUG-SGA和AGA组显著增高(P<0.01,P<0.05)。CUG-SGA 组胫骨生长板软骨细胞IGF-1表达较NCUG-SGA显著增多(P<0.01),与AGA组比较无显著差异;3组间IGF-1R表达无显著差异(P>0.05)。结论: SGA大鼠无论生后追赶与否均存在GH/IGF-1轴抵抗,其生后不同的线性生长追赶方式可部分归咎于其抵抗程度。     

IGF-I与宫内发育迟缓及其结合蛋白的关系

目的：检测宫内发育迟缓（IUGR）儿脐血胰岛素样生长因子-I（IGF-I）、胰岛素样生长因子结合蛋白-3（IGFBP-3）水平,分析这些指标的变化程度与胎儿期生长的关系。方法：将86例脐血标本分为IUGR（即小于胎龄儿）组和适于胎龄儿（AGA）组。采用放射免疫分析（RIA）测定IGF-I水平,免疫放射分析（IR-MA）测定IGFBP-3水平。两组间比较用t检验,两变量之间的关系采用相关回归分析。结果：与AGA组相比,IUGR组脐血IGF-I和IGFBP-3水平显著降低（P均〈0.01）;IGF-I、IGFBP-3均随胎龄及出生体重增加而增加（P均〈0.01）;IGFBP-3与IGF-I呈正相关（P〈0.01）。结论：脐血IGF-I和IGFBP-3的含量可作为判断新生儿生长发育程度的一项客观指标。     

Parenteral Nutrition Associated Cholestasis Is Earlier,More Prolonged and Severe in Small for Gestational Age Compared with Appropriate for Gestational Age Very Low Birth Weight Infants

Purpose

We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants.

Materials and Methods

Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin ≥2 mg/dL for ≥14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared.

Results

Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25±7 days vs. 35±14 days, p=0.002) and persisted longer (62±36 days vs. 46±27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin ≥4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase.

Conclusion

The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.     

尖锐湿疣患者治疗前后血清TNF-α、hs-CRP和GM-CSF检测的临床意义

目的：探讨了尖锐湿疣患者治疗前后血清TNF-α、hs-CRP和GM-CSF水平的变化及意义。方法：应用放射免疫分析和免疫比浊法对62例尖锐湿疣患者进行了血清TNF-α、hs-CRP和GM-CSF检测,并与35名正常健康人作比较。结果：在治疗前尖锐湿疣患者TNF-α、hs-CRP和GM-CSF水平均非常显著地高于正常人组（P〈0.01）。经3个月治疗后血清TNF-α、hs-CRP和GM-CSF水平与正常人组比较无显著性差异（P〉0.05）。患者组治疗前后血清TNF-α、hs-CRP和GM-CSF水平也有显著性差异（P〈0.01）。结论：检测尖锐湿疣患者血清TNF-α、hs-CRP和GM-CSF水平的变化对疾病的治疗、预后观察有重要的临床价值。     

Decreased maternal circulating hepatocyte growth factor (HGF) concentrations in pregnancies with small for gestational age infants

Our purpose was to evaluate whether maternal and fetal hepatocytegrowth factor (HGF) concentrations in pregnancies with smallfor gestational age (SGA) infants are different from those inpregnancies with appropriate for gestational age (AGA) infants.Maternal and fetal circulating HGF concentrations were comparedbetween 55 pregnancies with AGA infants and 16 pregnancies withSGA infants at birth. HGF concentrations were measured frommaternal and cord venous blood samples using an enzyme-linkedimmunosorbent assay. Umbilical artery blood pH and oxidativepressure (PO₂) were also measured. Maternal circulating HGFconcentrations (0.60 ± 0.35 ng/ml) in pregnancies withSGA infants were significantly lower than those (0.91 ±0.44 ng/ml) in pregnancies with AGA infants (P = 0.012). Therewere no significant differences in fetal circulating HGF concentrationsbetween both groups. No significant differences in umbilicalartery blood pH and PO₂ were found between both groups. Theseresults suggest that the maternal serum circulating HGF concentrationhas a significant role in fetal growth during pregnancy.     

急性肾炎患儿治疗前后血清GM-CSF、hs-CRP和IL-8联检的临床意义

目的：探讨了急性肾炎患儿治疗前后血清巨噬细胞集落刺激因子（GM-CSF）、超敏C-反应蛋白（hs-CRP）和IL-8水平的变化及意义。方法：应用放射免疫分析和免疫比浊法对31例急性肾炎患儿进行了血清GM-CSF、hs-CRP和IL-8测定,并与30名正常健康儿作比较。结果：急性肾炎患儿在治疗前血清GM-CSF、hs-CRP和IL-8水平均非常显著地高于正常儿组（P〈0.01）,经治疗6个月后则与正常儿比较无显著性差异（P〉0.05）。结论：检测血清GM-CSF、hs-CRP和IL-8水平的变化对观察病情和预后判定均具有重要的临床价值。     

胎盘胰高血糖素样肽-1水平与胎儿出生体重关系的研究

目的探讨胎盘胰高血糖素样肽-1(GLP-1)水平与胎儿出生体重的关系。方法采用免疫组织化学SABC法检测30例分娩正常出生体重儿组(AGA组)、28例高出生体重儿组(LGA组)及28例低出生体重儿组(SGA组)胎盘组织中GLP-1的表达水平。结果①LGA组胎盘组织中GLP-1的表达水平低于AGA组,差异有统计学意义(P<0.05)。SGA组胎盘组织中GLP-1的表达水平高于AGA组,差异有统计学意义(P<0.05)。②胎盘组织中GLP-1的表达水平与胎儿出生体重呈负相关(r=-0.454,P<0.05)。结论胎盘组织中GLP-1表达水平的变化可能在胎儿出生体重的调节中起重要作用。     

The Difference of Lymphocyte Subsets Including Regulatory T-Cells in Umbilical Cord Blood between AGA Neonates and SGA Neonates

Purpose

This study aimed to compare the regulatory T cells in cord blood of appropriate for gestational age (AGA) neonates with those of small for gestational age (SGA) neonates.

Materials and Methods

Umbilical cord blood was collected upon labor in 108 healthy full-term (between 37 and 41 gestational weeks) neonates, who were born between November 2010 and April 2012. Among them, 77 samples were obtained from AGA neonates, and 31 samples were obtained from SGA neonates. Regulatory T cells and lymphocyte subsets were determined using a flow cytometer. Student''s t-test for independent samples was used to compare differences between AGA and SGA neonates.

Results

Regulatory T cells in cord blood were increased in the SGA group compared with normal controls (p=0.041). However, cytotoxic T cells in cord blood were significantly decreased in the SGA group compared with normal controls (p=0.007).

Conclusion

This is the first study to compare the distribution of lymphocyte subsets including regulatory T cells in cord blood between AGA neonates and SGA neonates.     

Do gestational age and weight for gestational age predict concordance in parental perceptions of infant temperament?

Objective To study whether infant weight for gestational age,and gestational age predict mother- and father-rated infanttemperament (IBQ) at 6 months. Methods The sample comprisedof family units with both biological parents and infants bornat term (n = 152). Data on weight and gestational age were collectedform obstetric database. Results Infants born small for gestationalage (SGA) (weight < 10th percentile for gestational age)were rated by both parents as significantly more fearful andnegatively reactive compared to infants born appropriate forgestational age (AGA). Infants born SGA defined by using thelowest 15th or 20th percentile groups did not differ from AGAgroup in temperament. The weekly continuum of gestational agepredicted differences in parental ratings of infant temperamentalattentiveness. Conclusions The predictive significance of infantweight for gestational age and gestational age for behavioraloutcomes appear true also for infants born at term. Concordancein parental perceptions of an infant born SGA emphasizes theclinical significance of the findings.