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目的探讨胰岛素(Ins)、生长激素(GH)、皮质醇(Cor)与早产儿宫内发育迟缓(IUGR)的关系。方法采用放射免疫分析法检测40例IUGR早产儿和45例适于胎龄早产儿(对照组)母血、脐血和生后7日龄血清中的Ins、GH、Cor含量,并进行分析比较。结果Ins在IUGR组脐血、生后7日龄血清中的含量明显低于对照组(P<0.05)。GH、Cor在母血中含量明显低于对照组(P<0.05)。而脐血、生后7日龄血清中Cor含量在IU-GR高于对照组,但二组比较差异无显著性(P>0.05)。结论早产儿IUGR与Ins、GH、Cor等内分泌激素有关,它们通过调节代谢而影响胎儿宫内的生长发育,发挥着较重要的作用。     

The influence of Depot-β 1−24-Tetracosactide and of metyrapone on the excretion of free urinary cortisol in infants

In this paper we studied the urinary output of free cortisol using two experimental conditions: the first consists of basal values, a metyrapone test and a 3-days-load with tetracosactide. The second was carried out with a single dose of tetracosactid also after basal values.After metyrapone free urinary cortisol rose slighly less than the Porter-Silberchromogens the mean of raising factors being different with a p<0,02>0,01. The increase of free urinary cortisol may be used in this condition as a parameter for judging the capacity of C-11-hydroxylating enzyme system in basal state.After tetracosactide we found in both conditions an increase of urinary free cortisol showing a lens-effect regarding the values of the Porter-Silber-chromogens.It is concluded that free urinary cortisol can be used as a very sensitive parameter for judging increased adrenal activity, at least on premise of unaltered degradation rate of cortisol.We used in this study the ^1–24 with depot-effect from N. V. Organon, Oss, Netherlands.This study was supported by a grant (Sto 45/8) from the Deutsche Forschungsgemeinschaft, Bad Godesberg, West-Germany.     

Peripheral blood leucocyte zinc depletion in babies with intrauterine growth retardation.

The zinc content of peripheral blood leucocytes from the cord blood of 63 normal and 20 preterm babies, and of 27 babies with evidence of idiopathic intrauterine growth retardation (IUGR) was measured. Leucocyte zinc depletion was present in babies with acute IUGR (IUGR babies compared with controls, mean 47.8 v 51.5 ng zinc/mg dry weight), but was especially severe in those with prolonged IUGR (mean 43.2 ng zinc/mg dry weight), while preterm babies were normal (mean 51.9 ng zinc/mg dry weight). We suggest that this fetal tissue zinc depletion is caused by maternal zinc depletion, and may reflect a reduction of whole body zinc status.     

Endorphin and cortisol responses to surgical stress in newborns and infants

The beta-endorphin (BE) response to surgical stress in newborns and infants and its relation to pituitary-adrenal dynamics during stress is still unknown. Nine newborns 5 h to 5 days of age, and 5 infants 5 to 10 months old undergoing surgery were studied. All patients were anesthetized with N₂O–O₂ and halothane. Blood samples for BE and cortisol determinations were taken preoperatively and 30 min, 12 h, and 24 h after operation for radioimmunoassay. Both BE and cortisol levels in newborns were not significantly different from those in infants preoperatively (196±85.2 pg/ml vs. 138±47.8 pg/ml for BE and 23.7±17.5 g/dl vs. 10.1±5.6 g/dl for cortisol, P >0.05). At 30 min after operation, no significant increase in BE (220±106 pg/ml) and cortisol (36.1±21.2 g/dl) was found in newborns, while significant increases (BE 493±281 pg/ml, cortisol 43.9±24.2 g/dl) were found in infants compared to preoperative levels (both P <0.05). A significant difference between groups was seen in BE but not cortisol levels 30 min after operation. Both BE and cortisol declined to preoperative values within 24 h after surgery. Our study showed significant BE and cortisol responses to surgical stress in infants, but not in newborns. Factors such as age-related differential responses to the same anesthetic technique, duration of operation, and developmental differences in stress response are considered responsible for the differences.Supported by the Research Grant of Chang Gung Memorial Hospital, CMRP No. 176.     

宫内生长迟缓早产儿T淋巴细胞亚群水平变化

目的 了解宫内生长迟缓（IUGR）早产儿生后T淋巴细胞亚群水平及变化。方法 67例早产儿中IUGR早产儿29例,适于胎龄（AGA）早产儿38例;另取健康足月儿20例为对照组。采用流式细胞仪测定各组出生24 h内及校正胎龄38周时外周静脉血T淋巴细胞亚群水平;同时测定各时间点外周血白细胞、淋巴细胞及T淋巴细胞绝对计数。结果 24 h内IUGR早产儿CD3+、CD4+百分比低于AGA早产儿和对照组（P<0.05）,IUGR 早产儿CD8+及CD4+/CD8+低于对照组（P<0.05）,AGA早产儿CD3+、CD4+及CD4+/CD8+低于对照组（P<0.05）;IUGR早产儿外周血淋巴细胞低于对照组（P<0.05）,IUGR、AGA早产儿的T淋巴细胞低于对照组（P<0.05）,IUGR早产儿T淋巴细胞低于AGA早产儿（P<0.05）。校正胎龄38周时,IUGR、AGA早产儿CD3+、CD4+及CD4+/CD8+高于出生24 h内（P<0.05）,IUGR早产儿CD3+、CD4+、CD8+及CD4+/CD8+低于AGA早产儿（P<0.05）;IUGR与AGA早产儿外周血白细胞、淋巴细胞、T淋巴细胞比较差异无统计学意义（P >0.05）。结论 IUGR早产儿T淋巴细胞亚群免疫功能低于AGA早产儿及健康足月儿,并且持续至生后一段时间。     

Follow-up height after discontinuation of growth hormone treatment in children with intrauterine growth retardation

Growth hormone (GH) treatment has been used in children with intrauterine growth retardation (IUGR) to promote growth with success in several short- and long-term clinical trials. Intermittent GH therapy has also been advocated in children with IUGR. This study was designed to evaluate the growth of children with IUGR after discontinuation of a two-year trial of GH treatment. Sixteen children (12 F, 4 M) who had received GH (Genotropin) at age 5.3 (1.3) years at a dose of 0.2 IU/kg/day for 2 years (Group 1) and 10 (6 F, 4 M) controls of age 4.3 (1.7) years without treatment (Group 2) were followed after completion of the trial over a median period of 4 years. Height SDS of the GH-treated group showed an increase from -3.0 (0.5) to -1.9 (0.7) (p <0.001) over 2 years of therapy. Off therapy, height SDS decreased to -3.5 (0.5) at a mean age of 11.2 (1.6) years. The difference between the initial and recent height SDS in this group was significantly different (p = 0.02). Height SDS of the control group, -2.7 (1.4) initially, did not change over the two-year observation period. At follow-up, seven control children received GH in a similar fashion for one year. In spite of an insignificant increase in height SDS on one year of GH, it decreased to -2.9 (1.6) at age 11.0 (2.1) years at the latest visit. There was no significant difference between the recent heights of the two groups at final examination. One girl in Group 1 developed acanthosis nigricans and type 2 diabetes mellitus at age 13.3 years, after the follow-up period. A second patient developed osteosarcoma in the left tibia at age 9.9 years, for which she received chemotherapy and surgery. In conclusion, height SDS showed a significant increase on GH therapy for 2 years in children with IUGR; however, it decelerated after discontinuation of therapy. At the final visit, GH therapy did not seem to have had any effect on height prognosis. This finding shows that GH should be given continuously to improve final height in children with IUGR.     

休克新生儿血浆儿茶酚胺,皮质醇变化及其临床意义

为观察新生儿休克时血浆儿茶酚胺（CA）中去肾上腺素（NE）、肾上腺素（E）和皮质醇（CT）的动态变化，采用高效液相色谱-电化学法检测36例休克新生儿血浆NE、E的浓度，用放射免疫法测定血浆CT。结果，NE、E及CT的浓度明显高于对照组，分别为：NE16．0±3．0，2．9±1．1；E3.7±3.4，0.8±1．2，CT801±4，105±4（单位均为nmol／L，P均＜0．01）。感染性休克组NE高于非感染组（23．9±2．9nmol／L，10．7±2．7nmol／L，P＜0．05）。血浆NE、E浓度随病情加重而增高，提示抢救休克时血管活性药物应以扩血管为主．血浆NE、E值与毛细血管再充盈时间里显著正相关（P＜0·01），与血pH值是非常显著的负相关（P＜0.01），与血压无相关性，提示毛细血管再充盈时间及pH值是判所休克程度的较好指标。血浆CT增高可能系分泌增加和结合减少之故，提示休克时应及早应用糖皮质激素。     

宫内发育迟缓早产儿生后生长迟缓对早期神经发育的影响

目的 探讨宫内发育迟缓(IUGR)早产儿生后生长迟缓对早期神经发育的影响。方法 回顾性分析2008 年5 月至2012 年5 月出生并定期随访至校正胎龄6 个月的171例早产儿的临床资料,其中IUGR早产儿40 例,早产适于胎龄儿(AGA)131 例。比较两组校正胎龄40 周、3个月、6个月的生长迟缓率及校正胎龄3 个月、6 个月时的神经发育情况。神经发育采用Gesell发育量表评估。结果 IUGR 组校正胎龄40 周、3个月、6个月的生长迟缓率均明显高于AGA 组;校正胎龄3 个月时Gesell 各项发育商(大运动、精细动作、语言、适应性及个人社交)均低于AGA 组;校正胎龄6 个月时,IUGR组精细动作及语言发育商低于AGA组,但两组大运动、适应性及个人社交发育商比较差异已无统计学意义。IUGR组6月龄时体重追赶落后的患儿各项发育商均明显低于追赶理想的IUGR 和AGA 患儿。结论 IUGR早产儿生后早期的生长迟缓可对早期神经发育产生不良影响。     

Body size and neonatal hypoglycemia in intrauterine growth retardation

The relationship between blood glucose and body physique of 233 (42 hypo-and 191 normologycemic) intrauterine growth-retarded neonates was analyzed using different body measurements and indices of body proportions. Classification by combination of weight and length deficit for fetal age revealed that the disproportionately retarded infants (deficit in weight for age > 30%; deficit in length for age less than equal to 15%) were particularly prone to hypoglycemia. The lowest incidence of hypoglycemia was observed in the group with severe proportionate retardation (weight deficit for age > 30%; length deficit for age > 15%). Among the indices of body proportions ponderal index (W/L3), and percentage deviation from the expected weight for length turned out to be a sensitive predictor of the risk of hypoglycemia. The majority of hypoglycemia neonates were underweight for length and a considerable number of normoglycemic infants were overweight for length. These findings point to the significance of soft tissue wasting rather than low birth weight for gestational age itself, in the development and diagnosis of neonatal hypoglycemia. The significance of anthropometry in the classification of different types of intrauterine growth impairment, as well as in predicting specific hazards after birth is discussed.     

脓毒性休克患儿血清皮质醇和促肾上腺皮质激素水平的变化及临床意义

目的 研究脓毒性休克（SS）患儿血清皮质醇和促肾上腺皮质激素（ACTH）水平的动态变化,探讨其与病情严重程度及预后的关系。方法 25 例SS 失代偿期及24 例SS 早期患儿纳入研究。检测患儿入院时、入院第3 天、入院第8 天的血清皮质醇和ACTH 水平。25 例健康体检小儿作为正常对照组。SS 失代偿期组患儿根据其转归分为死亡组（n=5）与存活组（n=20）两个亚组。结果 入院时SS 失代偿期组和SS 早期组血清皮质醇和ACTH 水平均明显高于正常对照组（P P P P P P 结论 SS 患儿血清皮质醇、ACTH 水平增高,其水平的增高与患儿病情有关,持续高水平的血清皮质醇提示预后差,因此,动态监测SS 患儿的血清皮质醇、ACTH 对判断病情的严重程度及预后具有较高的临床价值。     

Influence of incubator humidity on sleep and behaviour of neonates kept at stable body temperature

The influence of incubator air humidity (via passive humidification through use of a water reservoir or via active humidification to 2 and 4 kPa) on sleep and behavioural changes was investigated in 13 neonates. The thermal environment of the incubator was servocontrolled via an interactive device tracking the skin temperature changes of the neonates. Using this servocontrolled skin temperature derivative heating programme, it is believed that an increase in air moisture content (reducing evaporative skin cooling) can be counterbalanced by a fall in neutral air temperature, so as to keep the body thermally constant. This procedure permits experimental evaluation of the specific effect of air humidity on the thermal equilibrium air temperature and the thermal comfort of neonates without eliciting thermoregulatory mechanisms. Under the experimental conditions, in order to keep body temperature stable an increase in water vapour partial pressure from 1.72 (water reservoir) to 3.99 kPa (produced by a nebulizer) is counterbalanced by a decrease in air temperature of 1.49°C. Within this humidity range, the air temperature must be lowered by 0.05°C when the vapour pressure is increased by 0.08 kPa. The magnitude of this deviation depends on the humidity range and is probably a result of changes in the wetted skin area.     

Thyroid hormone unresponsiveness in two siblings with intrauterine growth retardation and exophthalmos

Two cases of a brother and a sister with thyroid hormone unresponsiveness are described. They had large goiters and high levels of thyroid hormones in the face of clinical euthyroidism. The birth weight of the brother was low for his gestational age. He was also lean and exophthalmic, as is often seen in Graves' disease.Abbreviations used TSH thyrotropin - T4 thyroxine - PBI protein-bound iodine - BMR basal metabolic rate - T3 triiodothyronine - TRH thyrotropin releasing hormone - RT3U resin triiodothyronine uptake - TBG-C thyroxine binding capacity of thyroxine binding globulin - LATS long acting thyroid stimulator - hGH human growth hormone - LH luteinizing hormone - FSH follicle stimulating hormone - Gn-RH gonadotropin releasing hormone     

Growth, IGF system, and cortisol in children with intrauterine growth retardation: is catch-up growth affected by reprogramming of the hypothalamic-pituitary-adrenal axis?

Intrauterine growth retardation (IUGR) is one of the major causes of short stature in childhood. Although postnatal catch-up growth occurs in the majority of IUGR children, approximately 20% of them remain permanently short. The mechanisms that allow catch-up growth or, on the contrary, prevent IUGR children from achieving a normal height are still unknown. Our aim was to investigate whether intrauterine reprogramming of hypothalamic-pituitary-adrenal axis may be involved in postnatal growth retardation of IUGR children through a modulation of the function of the IGF system. Anthropometry, IGF system assessment, cortisol measurement, and lipid profile evaluation were performed in 49 IUGR children. Children were subdivided into two groups according to their actual height corrected for midparental height: CG (catch-up growth) group, 19 children with corrected height >or=0 z-score; and NCG (noncatch-up growth) group, 30 subjects with corrected height <0 z-score. CG children showed significantly higher birth weight (p < 0.005) and body mass index (p < 0.05). No significant differences in IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-3, soluble IGF-II receptor levels (IGF2R), IGF-II/IGF2R ratio, and relative amounts of IGFBP-3 circulating forms were found between CG and NCG children. None of the IGF system-related variables correlated with anthropometric indices. NCG children showed significantly higher concentrations of cortisol (p < 0.005) and cortisol levels resulted inversely to birth weigh (r = -0.34, p < 0.05), birth length (r = -0.36, p < 0.05), and corrected height (r = -0.44, p < 0.01). Whereas total and HDL cholesterol concentrations were not significantly different in the two groups, LDL cholesterol levels were significantly higher in NCG children (p < 0.05), and five of 49 showed LDL cholesterol concentrations >3.4 mM (130 mg/dL). LDL cholesterol was inversely related to birth weight (r = -0.31, p < 0.05), corrected stature (r = -0.32, p < 0.05), and actual height (r = -0.31, p < 0.05) and directly related to the levels of IGF2R (r = 0.44, p < 0.01). Reanalysis of 15 of 30 IUGR newborns in whom we previously reported an inverse relationship between cord blood cortisol levels and first trimester length gain (r = -0.54, p < 0.005) showed that the relative amount of the IGFBP-3 18-kD fragment was related inversely to cortisol (r = -0.67, p < 0.01) and directly to early postnatal growth (r = 0.65, p < 0.05). Our results suggest that catch-up growth in IUGR children might be affected by intrauterine reprogramming of hypothalamic-pituitary-adrenal axis, which may result in a permanent modification of the neuroendocrine response to stress: children with increased cortisol secretion may be at higher risk of growth failure. During the neonatal period cortisol might act by limiting IGFBP-3 proteolysis and, therefore, reducing IGF bioavailability.     

Study of genetic expression of intrauterine growth factors IGF-I and EGFR in placental tissue from pregnancies with intrauterine growth retardation

To investigate the possibility of altered gene expression of growth factors in prenatal growth retardation, we assessed expression of the genes for insulin-like growth factor-I (IGF-I) and epidermal growth factor receptor (EGFR) by RT-PCR from human placentas at term delivery in two groups: appropriate for gestational age (AGA) and pregnancies complicated with IUGR. The placentas from IUGR gestations showed reduced IGF-I expression with a significance of p = 0.008, whereas we did not find any significant differences in EGFR gene expression.