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目的分析小于胎龄儿婴儿期胰岛素敏感性的变化及早期不同喂养方式对其胰岛素敏感性的影响,为临床上对小于胎龄儿(SGA)早期营养干预提供了依据和线索。方法收集2011年6月-2014年6月在北京大学第三医院产科出生的小于胎龄儿为SGA组,正常对照(NC)组为同期同一家医院出生的健康适于胎龄儿(AGA)。两组新生儿进入本院儿童保健中心随访,进行常规体格测量,以及空腹血浆血糖(FPG)和空腹血清胰岛素(FINS)水平的测定,根据公式计算胰岛素抵抗指数(IRI)。根据生后4个月内的喂养方式不同,分为母乳喂养组、人工喂养组和混合喂养组,然后根据SGA组的IRI是否高于NC组的中位数将SGA又分为对胰岛素不敏感和对胰岛素敏感两组。结果 SGA组在1岁内生长发育速度快于NC组,但在1岁时仍未能追赶上NC组。在1岁时,SGA组婴儿的IRI值显著高于NC组(t=3.715,P<0.05)。生后早期母乳喂养较人工喂养和混合喂养的SGA胰岛素敏感性更高(χ~2=7.02,P<0.05)。结论 SGA在婴儿期生长发育速度快于正常体重儿,但未能追赶上正常体重儿。SGA在婴儿期末已经表现出胰岛素敏感性的差异。生后早期喂养方式不同对SGA的胰岛素敏感性可能有一定的影响。
Objective To analyze the changes of insulin sensitivity in infants with small gestational age and the effect of early different feeding methods on their insulin sensitivity, and provide the basis and clues for early nutritional intervention of small gestational age (SGA) clinics. Methods The SGA group was established in the obstetrics department of Peking University Third Hospital from June 2011 to June 2014. The normal control group (NC) group was healthy fit gestational age (AGA) . Two groups of newborns were enrolled in our hospital child health center for follow-up, routine physical measurement, fasting plasma glucose (FPG) and fasting serum insulin (FINS) were measured. The IRI was calculated according to the formula. According to the four months after birth, feeding methods are divided into breastfeeding group, artificial feeding group and mixed feeding group, and then according to SGA group IRI is higher than the median NC group SGA is divided into insulin insensitivity And insulin sensitivity in both groups. Results The growth of SGA group was faster than that of NC group within 1 year of age, but failed to catch up with NC group at the age of 1 year. At 1 year of age, infants in SGA group had significantly higher IRI than those in NC group (t = 3.715, P <0.05). Early postnatal breastfeeding was more sensitive than SGA insulin (χ ~ 2 = 7.02, P <0.05). Conclusion SGA grows faster than normal weight in infancy, but fails to catch up with normal weight. SGA has shown differences in insulin sensitivity at the end of infancy. Early postnatal feeding of different SGA insulin sensitivity may have some impact.