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目的研究早产小于胎龄儿(SGA)骨代谢与瞬时受体电位通道6(TRPV6)基因在胎盘组织中的表达特点,探讨宫内生长受限对早产儿骨健康的影响。方法选取2009年2月至2010年1月在我院产科出生2 h内入住我科的新生儿,按照胎龄和出生体重分别纳入早产SGA组、早产适于胎龄儿组(早产AGA组)和足月AGA组。新生儿母亲于分娩前48 h内检测血清钙、磷、碱性磷酸酶(ALP)及25-羟维生素D_3(25-OHD_3)浓度;新生儿生后24 h内检测血清钙、磷、ALP及25-OHD_3浓度,生后72 h内定量超声仪测量左胫骨声波速度(SOS)值;实时定量PCR方法检测胎盘TPRV6 mRNA的表达。结果各组新生儿母亲分娩前血清钙、磷、ALP及25-OHD_3浓度差异均无统计学意义(P>0.05),各组新生儿血清钙、磷及ALP浓度差异无统计学意义(P>0.05);足月AGA组血清25-OHD_3水平高于早产AGA组和早产SGA组[(55.9±26.7)nmol/L比(33.7±16.3)nmol/L、(28.8±10.8)nmol/L,P<0.05],早产AGA组高于早产SGA组(P<0.05);早产SGA组骨SOS值低于早产AGA组和足月AGA组[(2 994.6±23.2)m/s比(3 085.5±205.3)m/s、(3 079.3±127.4)m/s,P<0.05],早产AGA组和足月AGA组差异无统计学意义(P>0.05);足月AGA组TRPV6 mRNA表达量高于早产AGA组及SGA组[(1.14±0.10)比(0.95±0.07)、(0.86±0.08),P<0.05],早产AGA组高于早产SGA组(P<0.05)。早产儿骨SOS值与胎龄成正相关(r=0.310,P<0.01),血清25-OHD_3水平、TRPV6基因mRNA表达量与出生体重成正相关(r=0.317、0.529,P<0.01),其他指标与胎龄和体重均无关;新生儿骨SOS值与血清钙、25-OHD_3水平成正相关(r=0.311、0.330,P=0.008、0.014),与血清磷、ALP无相关。结论早产SGA骨矿化密度及胎盘TRPV6 mRNA表达水平均较低,应加强对早产SGA骨代谢的管理及监测。
Objective To study the expression of bone metabolism and transient receptor potential channel 6 (TRPV6) gene in placenta of premature newborn infants with small gestational age (SGA) and to investigate the effect of intrauterine growth restriction on bone health in premature infants. Methods From February 2009 to January 2010, newborns admitted to our department within 2 h of obstetrics in our hospital were enrolled in preterm labor SGA group and premature labor in gestational age group (premature labor AGA group) according to gestational age and birth weight. And term AGA group. Neonatal mothers detected serum levels of calcium, phosphorus, alkaline phosphatase (ALP) and 25-hydroxyvitamin D3 (25-OHD_3) within 48 hours before delivery. Serum Ca, P and ALP 25-OHD_3 concentrations were measured within 72 h after birth by quantitative ultrasound system, the left tibia acoustic velocity (SOS) value; real-time quantitative PCR method to detect placenta TPRV6 mRNA expression. Results There was no significant difference in serum calcium, phosphorus, ALP and 25-OHD_3 concentrations before delivery between mothers in each group (P> 0.05). There was no significant difference in serum calcium, phosphorus and ALP concentrations between newborns in each group (P> 0.05). Serum levels of 25-OHD 3 in term AGA group were higher than those in preterm AGA group and preterm SGA group (55.9 ± 26.7 nmol / L, 33.7 ± 16.3 nmol / L, 28.8 ± 10.8 nmol / L, P (P <0.05). The SOS of premature SGA group was lower than that of AGA preterm group and term AGA group (2994.6 ± 23.2) m / s (3 085.5 ± 205.3) (3 079.3 ± 127.4) m / s, P <0.05]. The expression of TRPV6 mRNA in term AGA group was higher than that in preterm group AGA group and SGA group [(1.14 ± 0.10) vs (0.95 ± 0.07), (0.86 ± 0.08), P <0.05]. The preterm labor AGA group was higher than preterm SGA group (P <0.05). There was a positive correlation between SOS value of preterm infants and gestational age (r = 0.310, P <0.01), serum 25-OHD_3 level and TRPV6 mRNA expression (r = 0.317,0.529, P <0.01) Neonatal bone SOS value and serum calcium, 25-OHD_3 levels were positively correlated (r = 0.311,0.330, P = 0.008, 0.014), and serum phosphorus, ALP no correlation. Conclusions The density of SGA bone mineralization and the expression level of TRPV6 mRNA in placenta are low in preterm delivery. The management and monitoring of bone metabolism in SGA should be strengthened.