早产婴幼儿追赶生长对骨龄发育影响的队列研究

目的了解早产儿在婴幼儿期的追赶生长情况,探索早产儿追赶生长对骨龄发育的影响。方法采用双向队列研究的方法,选取2015年1月1日至12月31日在武汉儿童医院儿童保健科就诊的早产儿为暴露组,按照1∶1的比例选取同年龄、同性别、同种族的足月儿为非暴露组,回顾性收集2组婴儿出生史、既往生长发育史等资料,并随访至3岁。3岁时2组儿童拍摄左腕部X线片进行骨龄评价。结果入组时暴露组和非暴露组研究对象各392例,随访至3岁时暴露组239例,非暴露组247例。随访过程中暴露组儿童的身长、体质量均存在追赶生长的趋势,体质量Z值在2月龄最低,但体质量和身长的总体水平仍落后于非暴露组。体质量的追赶优先于身长,体现在体质量追赶至Z=-2和Z=-1的时间分别为3.78个月、16.18个月,身长追赶至Z=-2和Z=-1的时间分别为7.24个月、22.21个月,身长在5~10月龄和12~21月龄期间追赶速度变缓。2组儿童进行骨龄评价的年龄在2.80~3.20岁(平均3.03岁),暴露组男童骨龄[(3.13±0.61)岁]高于非暴露组[(2.75±0.51)岁],差异有统计学意义(t=-5.52,P<0.01),暴露组女童骨龄[(3.23±0.57)岁]与非暴露组[(3.15±0.54)岁]比较,差异无统计学意义(t=-1.08,P>0.05)。1月龄、2月龄、4月龄、5月龄、6月龄、12月龄的身长Z值和2月龄、3月龄、4月龄体质量Z值是骨龄发育的促进因素,15月龄、18月龄、36月龄的身长Z值和15月龄的体质量Z值是骨龄发育的阻碍因素。结论早产儿在3岁前存在追赶生长趋势,避免1岁前体质量、身长的快速追赶生长可延缓骨龄发育。

Impact of catch-up growth on bone age development in preterm infants from a cohort study

Objective To evaluate the catch-up growth features of preterm infants and to explore the influence of catch-up growth on bone age development.Methods The two-way cohort study was conducted.The preterm infants who visited the Child Health Department of Wuhan Children′s Hospital from January 1^st to December 31^th in 2015 were selected as the exposed group and the full term infants with age,gender and ethnicity matched with the exposed group ones were selected according to the ratio of 1∶1 for the non-exposed group who visited the same hospital at the same time non.Information of those childeren as the birth history,past birth and development history were collected in both groups were followed up till 3 years old and photographed on the left wrist X-ray film for bone age evaluation at 3 years old.Results At the time of enrollment,392 subjects were selected in the exposed group and non-exposed group and 239 infants in the exposed group and 247 infants in non-exposed group were followed up till 3 years.During the follow-up period,there was a conspicuous catch-up growth trend of body length and weight in the exposed group,and weight Z score was the lowest at 2 months old,but the overall level of body length and weight were still lower than the non-exposed group.The start of catching up growth in body weight took precedence over the length,which was reflected in the time when the weight caught up to Z=-2 and Z=-1 as 3.78 months old and 16.18 months old,whereas the time of length catching up to Z=-2 and Z=-1 was 7.24 months old and 22.21 months old.The length catch-up growth was slower during the period of 5-10 months old and 12-21 months old.The age of bone age assessment in the 2 groups was between 2.80 and 3.20 years old(mean 3.03 years old).The bone age of boys in the exposed group was higher than that of the non-exposed ones[(3.13±0.61)years old vs.(2.75±0.51)years old],and there was statistical significance(t=-5.52,P<0.01),but there was no significant difference in bone age between girls of the 2 groups[(3.23±0.57)years vs.(3.15±0.54)years old](t=-1.08,P>0.05).Body length Z-score at the age of 1 month,2 months,4 months,5 months,6 months,12 months and weight Z-score at 2 months,3 months,4 months were the facilitating factors for skeletal development,whereas body length Z-score at 15 months,18 months,36 months and weight Z-score at 15 months were obstacles.Conclusions Premature infant have a catch-up trend before 3 years old.In order to delay the skeletal development,it is necessary to avoid rapid catch-up growth of weight and length in premature infants before 1 year old.