Norman Mikael, Martin Helena
Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
Circulation. 2003 Aug 26;108(8):996-1001. doi: 10.1161/01.CIR.0000085069.09770.3D. Epub 2003 Aug 18.
Low birth weight predisposes to later coronary disease. To further elucidate the mechanisms behind this association and their timing, vascular endothelial function-a key factor in early pathophysiology of atherosclerosis-was studied in 54 infants born either before the third trimester or at term.
All subjects were studied at 3 months of postnatal age. A laser-Doppler technique was used to measure skin perfusion before and after transdermal iontophoresis of acetylcholine (ACh; an endothelium-dependent vasodilator). In infants born at term (n=19; birth weight range: 2230 to 4205 g), maximum perfusion after ACh was 109+/-8 perfusion units (PU, mean+/-SEM) in normal-birth weight controls compared with 56+/-13 PU among those who had been small for gestational age at birth (P<0.01). In infants born preterm (n=35; birth weight range, 722 to 1868 g), ACh induced similar perfusion responses among subjects appropriate for gestational age (113+/-16 PU) and in those small for gestational age at birth (109+/-19 PU).
Impairment in human endothelial function associated with low birth weight occurs or emerges late in pregnancy. Very preterm birth attenuates this association. Different gene-environment interactions in the third trimester may contribute to this finding.
低出生体重易导致日后患冠心病。为进一步阐明这种关联背后的机制及其发生时间，我们对54名在孕晚期前出生或足月出生的婴儿进行了研究，血管内皮功能是动脉粥样硬化早期病理生理学的关键因素。
所有受试者均在出生后3个月进行研究。采用激光多普勒技术测量乙酰胆碱（ACh，一种内皮依赖性血管舒张剂）经皮离子电渗前后的皮肤灌注。在足月出生的婴儿（n = 19；出生体重范围：2230至4205 g）中，正常出生体重对照组在ACh刺激后的最大灌注为109±8灌注单位（PU，平均值±标准误），而出生时小于胎龄的婴儿为56±13 PU（P<0.01）。在早产婴儿（n = 35；出生体重范围，722至1868 g）中，ACh在适于胎龄的受试者（113±16 PU）和出生时小于胎龄的受试者（109±19 PU）中诱导出相似的灌注反应。
与低出生体重相关的人类内皮功能损害发生于妊娠晚期或在妊娠晚期出现。极早产会减弱这种关联。孕晚期不同的基因-环境相互作用可能导致了这一结果。
