Hofman Paul L, Regan Fiona, Jackson Wendy E, Jefferies Craig, Knight David B, Robinson Elizabeth M, Cutfield Wayne S
Liggins Institute, Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand.
N Engl J Med. 2004 Nov 18;351(21):2179-86. doi: 10.1056/NEJMoa042275.
Term infants who are small for gestational age appear prone to the development of insulin resistance during childhood. We hypothesized that insulin resistance, a marker of type 2 diabetes mellitus, would be prevalent among children who had been born prematurely, irrespective of whether they were appropriate for gestational age or small for gestational age.
Seventy-two healthy prepubertal children 4 to 10 years of age were studied: 50 who had been born prematurely (32 weeks' gestation or less), including 38 with a birth weight that was appropriate for gestational age (above the 10th percentile) and 12 with a birth weight that was low (i.e., who were small) for gestational age, and 22 control subjects (at least 37 weeks' gestation, with a birth weight above the 10th percentile). Insulin sensitivity was measured with the use of paired insulin and glucose data obtained by frequent measurements during intravenous glucose-tolerance tests.
Children who had been born prematurely, whether their weight was appropriate or low for gestational age, had an isolated reduction in insulin sensitivity as compared with controls (appropriate-for-gestational-age group, 14.2x10(-4) per minute per milliunit per liter [95 percent confidence interval, 11.5 to 16.2]; small-for-gestational-age group, 12.9x10(-4) per minute per milliunit per liter [95 percent confidence interval, 9.7 to 17.4]; and control group, 21.6x10(-4) per minute per milliunit per liter [95 percent confidence interval, 17.1 to 27.4]; P=0.002). There were no significant differences in insulin sensitivity between the two premature groups (P=0.80). As compared with controls, both groups of premature children had a compensatory increase in acute insulin release (appropriate-for-gestational-age group, 2002 pmol per liter [95 percent confidence interval, 1434 to 2432] [corrected]; small-for-gestational-age group, 2253 pmol per liter [95 percent confidence interval, 1622 to 3128]; and control group, 1148 pmol per liter [95 percent confidence interval, 875 to 1500]; P<0.001).
Like children who were born at term but who were small for gestational age, children who were born prematurely have an isolated reduction in insulin sensitivity, which may be a risk factor for type 2 diabetes mellitus.
足月小样儿在儿童期似乎易于发生胰岛素抵抗。我们推测，作为2型糖尿病标志的胰岛素抵抗在早产儿中很普遍，无论他们是适于胎龄儿还是小于胎龄儿。
对72名4至10岁健康的青春期前儿童进行了研究：50名早产儿（孕周32周或更短），其中38名出生体重适于胎龄（高于第10百分位数），12名出生体重低（即小于胎龄）；22名对照者（孕周至少37周，出生体重高于第10百分位数）。通过静脉葡萄糖耐量试验期间频繁测量获得的配对胰岛素和葡萄糖数据来测量胰岛素敏感性。
与对照组相比，早产儿无论出生体重适于胎龄还是小于胎龄，均出现单纯性胰岛素敏感性降低（适于胎龄组，每分钟每毫单位每升14.2×10⁻⁴[95%可信区间，11.5至16.2]；小于胎龄组，每分钟每毫单位每升12.9×10⁻⁴[95%可信区间，9.7至17.4]；对照组，每分钟每毫单位每升21.6×10⁻⁴[95%可信区间，17.1至27.4]；P=0.002）。两个早产组之间胰岛素敏感性无显著差异（P=0.80）。与对照组相比，两组早产儿的急性胰岛素释放均有代偿性增加（适于胎龄组，每升2002皮摩尔[95%可信区间，1434至2432][校正]；小于胎龄组，每升2253皮摩尔[95%可信区间，1622至3128]；对照组，每升1148皮摩尔[95%可信区间，875至1500]；P<0.001）。
与足月小样儿一样，早产儿也有单纯性胰岛素敏感性降低，这可能是2型糖尿病的一个危险因素。
