宫内发育迟缓对新生儿胰岛素敏感性和脂联素水平的影响

Effect of intrauterine growth retardation on insulin sensitivity and plasma adiponectin level in neonates

摘要:

目的 探讨宫内发育迟缓（IUGR）对新生儿胰岛素敏感性的影响，并研究IUGR新生儿胰岛素敏感性和血浆脂联素水平的关系。方法 选择出生后24 h内住院的足月新生儿，按出生体重分为IUGR组（82例）和非IUGR组（90例），均于出生24 h内测量体格生长指数，生后第7天检测空腹血糖、TG、LDL、HDL、血浆脂联素和胰岛素水平，并计算稳态模型胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（ISI）。结果 IUGR组和非IUGR组空腹血糖、TG、LDL和HDL水平的差异均无统计学意义（P > 0.05）。与非IUGR组比较，IUGR组胰岛素水平较高，血浆脂联素水平较低，HOMA-IR较高，ISI较低，差异均有统计学意义（P < 0.05）。Pearson相关分析和多元线性回归分析均显示HOMA-IR与脂联素、出生体重呈负相关（P < 0.05）。结论 IUGR新生儿血胰岛素水平升高、敏感性降低，有发生胰岛素抵抗倾向，可能与IUGR新生儿脂联素水平降低有关。

Abstract:

Objective To explore the effect of intrauterine growth retardation (IUGR) on insulin sensitivity in neonates and the relationship between insulin sensitivity and plasma adiponectin level.Methods Eighty-two term neonates with IUGR and 90 term neonates born appropriate for gestational age (AGA) were enrolled. Weight, height, head circumference and abdomen circumference of the neonates were measured within 24 hours after birth. Fasting serum glucose (FG), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), plasma insulin and adiponectin were detected in two groups on the 7th day after birth. Homeostasis model assessment for insulin resistance (HOMA-IR) index and insulin sensitivity index (ISI) were calculated.Results There were no significant differences in the levels of FG, TG, HDL and LDL between the IUGR and AGA groups (P > 0.05). The plasma insulin level in the IUGR group was higher than that in the AGA group, but the plasma adiponectin level was lower than that in the AGA group (P < 0.05). HOMA-IR index in the IUGR group was higher than that in the AGA group, but ISI was lower than that in the AGA group (P < 0.05). Both Pearson correlation analysis and multiple linear regression analysis showed HOMA-IR index was negatively correlated with plasma adiponectin level and birth weight (P < 0.05).Conclusions The neonates with IUGR display a higher plasma insulin level and decreased insulin sensitivity. The decreased plasma adiponectin level may be associated with the decreased insulin sensitivity.