本文選題：早產(chǎn)兒及低體重兒 + 追趕生長(zhǎng)　； 參考：《陜西中醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：隨著全球經(jīng)濟(jì)、衛(wèi)生條件的改善和醫(yī)療水平的提高，早產(chǎn)兒（premature baby胎齡37周）、低出生體重兒（Low birth weight LBW,出生體重2500g）的存活率越來(lái)越高。長(zhǎng)期以來(lái)，追趕生長(zhǎng)都被認(rèn)為是機(jī)體從發(fā)育遲緩或生長(zhǎng)停滯的病理狀態(tài)中加速恢復(fù)的過(guò)程，，是機(jī)體的一種自我代償和保護(hù)機(jī)制。因此本研究旨在探討咸陽(yáng)市早產(chǎn)兒及低體重兒幼兒期追趕生長(zhǎng)代謝特征及與胰島素敏感性的關(guān)系。 方法：對(duì)2010年4月～2012年4月215例咸陽(yáng)市就診咸陽(yáng)市婦產(chǎn)醫(yī)院和咸陽(yáng)市彩虹醫(yī)院兒科2010年4月-2012年4月出生的早產(chǎn)兒(胎齡37周)、低出生體重兒(LBW，出生體重2500g),除外有難產(chǎn)史，新生兒畸形及嚴(yán)重缺血缺氧疾病，圍產(chǎn)窒息以及母親妊娠糖尿病，神經(jīng)系統(tǒng)疾病的幼兒，在征得家長(zhǎng)同意后均列為研究對(duì)象。對(duì)照組30例隨機(jī)選自同期出生的健康適于胎齡兒（AGA）,上述正常兒及早產(chǎn)兒及低體重兒診斷標(biāo)準(zhǔn)依據(jù)第4版《實(shí)用新生兒學(xué)》制定。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(x s)表示，計(jì)數(shù)資料以百分?jǐn)?shù)(%)表示，所得結(jié)果運(yùn)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行方差分析、t檢驗(yàn)和相關(guān)分析等。 結(jié)果：SGA兒出生時(shí)測(cè)得身高和體重SDS值均低于AGA兒，餐前空腹血糖測(cè)量?jī)山M比較差異無(wú)顯著性，但是胰島素水平和HOMA值SGA組明顯高于AGA組;HOMA值高于AGA組；SGA兒追趕生長(zhǎng)速度與胰島素及HOMA值呈明顯負(fù)相關(guān)(P0.05)；2歲時(shí)SGA兒組和AGA兒組相比，身高和體重SDS值無(wú)明顯差異性，測(cè)餐前空腹血糖、胰島素水平高于AGA組，HOMA值也高于AGA組，SGA兒經(jīng)過(guò)追趕生長(zhǎng)，測(cè)的值達(dá)到正常水平;2歲時(shí)測(cè)甘油三酯和總膽固醇SGA組和AGA組相比，SGA組顯著高于AGA組；在SGA兒中11名體重身長(zhǎng)均未出現(xiàn)追趕生長(zhǎng)者,其胰島素水平和HOMA值均顯著高于出現(xiàn)追趕生長(zhǎng)組[胰島素(13.750.99)mU/L vs (5.870.85) mU/L, P0.01; HOMA值(2.00.64)v s (1.350.26), P 0.01] 結(jié)論：1.SGA兒出生時(shí)測(cè)得身高、體重和身高體重的SDS值均低于AGA兒，餐前空腹血糖測(cè)量?jī)山M比較差異無(wú)顯著性，但是胰島素水平值和HOMA值SGA組明顯高于AGA組;HOMA值高于AGA組;在出生時(shí)SGA兒和AGA兒身高、體重、血糖和胰島素及HOMA值有明顯差異，影響危險(xiǎn)因素有多種；2.2歲時(shí)SGA經(jīng)過(guò)追趕生長(zhǎng)及后天營(yíng)養(yǎng)干預(yù)等，測(cè)的身高和體重及身高、體重的SDS值值達(dá)到正常水平，胰島素水平值和HOMA值SGA組略高于AGA組；3.SGA兒在經(jīng)過(guò)追趕生長(zhǎng)后，測(cè)甘油三酯和總膽固醇已達(dá)到正常水平，堆積的內(nèi)臟脂肪與血脂有明顯關(guān)系；4.SGA在2歲內(nèi)追趕速度最快，通過(guò)喂養(yǎng)方式、后天體育鍛煉及父母后期生活干預(yù)等，可以加快其追趕速度，早產(chǎn)兒及低體重兒追趕生長(zhǎng)速度與胰島素敏感性密切相關(guān)，追趕速度越慢，胰島素敏感性越低。
[Abstract]:Objective: with the improvement of global economy, health condition and medical treatment, the survival rate of low birth weight (low birth weight 2500g) is increasing in premature infants at 37 weeks of gestation. For a long time, chasing growth has been regarded as a process of accelerating recovery from the pathological state of growth retardation or stagnation, as well as a mechanism of self-compensation and protection. The aim of this study was to investigate the relationship between the catch-growth metabolism and insulin sensitivity of premature and low birth weight infants in Xianyang. Methods: from April 2010 to April 2012, 215 cases of premature infants (gestational age 37 weeks) born in Xianyang Gynecology Hospital and Xianyang Rainbow Hospital from April 2010 to April 2012, low birth weight infants (LBW, birth weight 2500g), with the exception of history of dystocia, were studied. Children with neonatal malformation, severe ischemic and hypoxic diseases, perinatal asphyxia, maternal diabetes mellitus and neurological diseases were all included in the study with parental consent. In the control group, 30 cases of healthy and suitable gestational age (AGA) were randomly selected from the same period. The diagnostic criteria of the above mentioned normal infants, premature infants and low birth weight infants were formulated according to the 4th edition of practical Neonatology. The measured data were expressed as mean 鹵standard deviation (x s), and the counting data were expressed as percentage (%). The results were analyzed by ANOVA and correlation analysis using SPSS 17.0 statistical software. Results the height and weight of SGA were lower than that of AGA at birth. There was no significant difference in fasting blood glucose between the two groups, but the insulin level and Homa in SGA group were significantly higher than those in AGA group and AGA group. There was significant negative correlation between the catch-up growth rate of SGA and insulin and HOMA (P0.05). There was no significant difference in height and SDS between SGA and AGA at the age of 2. Fasting blood glucose was measured before meal. The level of insulin was higher than that of AGA group (Homa) and higher than AGA group (P < 0.05). The level of insulin was significantly higher in SGA group than in AGA group at the age of 2 years, and the level of triglyceride and total cholesterol in SGA group was significantly higher than that in AGA group. The insulin level and Homa value in 11 SGAs were significantly higher than those in the catch-up growth group [insulin (13.750.99) MU / L vs (5.870.85) MU / L, P0.01; Homa (2.00.64) v s (1.350.26), P 0.01] conclusion: 1. The SDS values of weight and height weight were lower than those of AGA children. There was no significant difference in fasting blood glucose measurement between the two groups, but the insulin level and HOMA values in SGA group were significantly higher than those in AGA group, and the height and weight of SGA and AGA children at birth were significantly higher than those in AGA group. There were significant differences in blood glucose, insulin and Homa. The risk factors were SGA after catch-up growth and postnatal nutrition intervention at 2.2 years old. The height, weight, height and SDS value of body weight reached the normal level. The levels of insulin and Homa in SGA group were slightly higher than those in AGA group. 3. After catching up and growing, triglyceride and total cholesterol had reached normal level, and the accumulation of visceral fat was significantly related to blood lipids. 4. SGA was the fastest catching up rate within 2 years of age. The catch-up rate of premature infants and low birth weight infants was closely related to insulin sensitivity. The slower the catching up speed, the lower the insulin sensitivity.
【學(xué)位授予單位】：陜西中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R722.6

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