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目的探讨无生长追赶小于胎龄儿(SGA)胰岛素敏感性及垂体-甲状腺轴的变化。方法选择近3年中山大学附属第一医院儿科内分泌专科门诊的青春前期生长迟缓儿童,按性别、年龄、体块指数(BMI)匹配分为两组,即无生长追赶SGA组和矮小适于胎龄儿组(AGA),各24例进行病例对照研究。两组均检测空腹血糖、血清胰岛素及血清TSH、T3、T4,并计算血糖/胰岛素比值(G/I比值)、胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA%)。结果SGA组空腹血糖与AGA组比较无显著性差异,但空腹胰岛素、HOMA-IR、HOMA%均显著高于AGA组(8.0±6.2vs4.4±2.8mU/L,1.8±1.4vs1.0±0.7和183.0±145.9vs70.8±43.6,P均<0.05);SGA组HOMA-IR>3人数显著高于AGA组(7/24vs1/24,P<0.05);G/I比值显著低于AGA组(17.8±15.1vs33.2±28.9,P<0.05)。SGA组血清TSH显著高于AGA组(2.9±0.8vs1.9±0.9mU/L,P<0.01),而血清T3、T4两组比较差异无统计学意义。SGA血清胰岛素、HOMA-IR与出生体重SDS呈负相关(r=-0.547和-0.482,P均<0.05);SGA血清TSH与出生身长SDS呈负相关(r=-0.571,P<0.01)。结论无生长追赶SGA存在胰岛素抵抗和垂体-甲状腺轴的改变,无生长追赶SGA需要长期随访和早期干预,以预防或延缓代谢综合征发生。
Objective To investigate the changes of insulin sensitivity and pituitary - thyroid axis in children without growth catch-up (SGA). Methods Children with pre-puberty growth retardation in pediatric endocrinology specialist clinic of the First Affiliated Hospital of Sun Yat-sen University in the past three years were divided into two groups according to gender, age, body mass index (BMI) matching, that is, no growth catch-up SGA group and short suitable for fetal Age group (AGA), 24 cases of each case-control study. Fasting blood glucose, serum insulin and serum TSH, T3, T4 were measured in both groups. Blood glucose / insulin ratio (G / I ratio), insulin resistance index (HOMA-IR) and islet β cell function (HOMA%) were calculated. Results There was no significant difference in fasting blood glucose between SGA group and AGA group, but fasting insulin, HOMA-IR and HOMA% were significantly higher than those of AGA group (8.0 ± 6.2 vs 4.4 ± 2.8mU / L, 1.8 ± 1.4vs1.0 ± 0.7 and 183.0 ± 145.9 vs 70.8 ± 43.6, P <0.05). The number of HOMA-IR> 3 in SGA group was significantly higher than that in AGA group (7 / 24vs1 / 24, P <0.05) Group (17.8 ± 15.1 vs. 33.2 ± 28.9, P <0.05). Serum TSH in SGA group was significantly higher than that in AGA group (2.9 ± 0.8 vs 1.9 ± 0.9mU / L, P <0.01), but there was no significant difference in serum T3 and T4 between the two groups. SGA serum insulin, HOMA-IR and birth weight SDS was negatively correlated (r = -0.547 and -0.482, P all <0.05); SGA serum TSH negatively correlated with birth length SDS (r = -0.571, P <0.01). Conclusions There is insulin resistance and pituitary-thyroid axis change in growth-free SGA. No growth-catch-up SGA requires long-term follow-up and early intervention to prevent or delay the development of metabolic syndrome.