Koklu Esad, Kurtoglu Selim, Akcakus Mustafa, Yikilmaz Ali, Gunes Tamer
Erciyes University, School of Medicine, Department of Pediatrics, Division of Neonatology, 38039 Kayseri, Turkey.
Growth Horm IGF Res. 2007 Feb;17(1):26-32. doi: 10.1016/j.ghir.2006.10.002. Epub 2006 Nov 20.
Exposure to diabetes in utero has been established as a significant risk factor for some of the components of metabolic syndrome, and was associated with increased levels of maternal, placental, and fetal insulin-like growth factors and leptin. The atherogenic effects of leptin and insulin-like growth factor-I (IGF-I) have been extensively described. The present study was therefore designed to investigate relationships between abdominal aortic intima-media thickness (aIMT), serum IGF-I, IGF binding protein-3 (IGFBP-3) and leptin levels in macrosomic newborns.
Neonates whose birth weights exceed 90th percentile for gestational age and gender are termed macrosomic. Abdominal aortic intima-media thickness was measured in 30 macrosomic neonates of diabetic mothers (group A), 30 macrosomic neonates of healthy mothers (group B) and 30 healthy neonates (group C). Serum IGF-I, IGFBP-3 and leptin levels were determined in all infants and their mothers. Stepwise logistic regression analysis was used to determine independent risk factors for aortic intima-media thickness.
Mean aortic intima-media thickness was significantly higher in groups A and B (0.489+/-0.015,0.466+/-0.019 mm, respectively) than in controls (0.375+/-0.024 mm, p<0.0001). Weight-adjusted aortic intima-media thickness was significantly higher in-group A than in groups B (p=0.004) and C (p=0.048). Serum leptin concentration in-group B (37.4+/-10.7 ng/ml) was significantly greater than in-group C (23.5+/-7.1 ng/ml, p<0.0001), but significantly lower than in-group A (46.6+/-14.1 ng/ml, p<0.0001). Serum IGF-I levels of the infants were significantly lower in-group C (113.2+/-33.1 ng/ml) than in groups A and B (205.2+/-60.1 and 179.3+/-55.1 ng/ml respectively, p<0.0001). Serum IGF-I, IGFBP-3 and leptin levels of the infants were positively correlated with mean (p<0.0001) and weight-adjusted aortic intima-media thickness measurements (p=0.003, p=0.006 and p=0.001, respectively).
Macrosomic neonates of diabetic mothers have significantly increased aortic intima-media thickness with higher serum IGF-I, IGFBP-3 and leptin concentrations than those of controls. It might be speculated that these changes may exaggerate the atherosclerotic process later in life.
子宫内暴露于糖尿病已被确认为代谢综合征某些组分的重要危险因素，且与母体、胎盘和胎儿胰岛素样生长因子及瘦素水平升高有关。瘦素和胰岛素样生长因子-I（IGF-I）的致动脉粥样硬化作用已被广泛描述。因此，本研究旨在探讨巨大儿新生儿腹主动脉内膜中层厚度（aIMT）、血清IGF-I、IGF结合蛋白-3（IGFBP-3）和瘦素水平之间的关系。
出生体重超过同胎龄和性别的第90百分位数的新生儿被称为巨大儿。对30例糖尿病母亲的巨大儿新生儿（A组）、30例健康母亲的巨大儿新生儿（B组）和30例健康新生儿（C组）测量腹主动脉内膜中层厚度。测定所有婴儿及其母亲的血清IGF-I、IGFBP-3和瘦素水平。采用逐步逻辑回归分析确定主动脉内膜中层厚度的独立危险因素。
A组和B组的平均主动脉内膜中层厚度（分别为0.489±0.015、0.466±0.019mm）显著高于对照组（0.375±0.024mm，p<0.0001）。体重校正后的主动脉内膜中层厚度A组显著高于B组（p=0.004）和C组（p=0.048）。B组血清瘦素浓度（37.4±10.7ng/ml）显著高于C组（23.5±7.1ng/ml，p<0.0001），但显著低于A组（46.6±14.1ng/ml，p<0.0001）。C组婴儿血清IGF-I水平（113.2±33.1ng/ml）显著低于A组和B组（分别为205.2±60.1和179.3±55.1ng/ml，p<0.0001）。婴儿的血清IGF-I、IGFBP-3和瘦素水平与平均（p<0.0001）及体重校正后的主动脉内膜中层厚度测量值呈正相关（分别为p=0.003、p=0.006和p=0.001）。
糖尿病母亲的巨大儿新生儿主动脉内膜中层厚度显著增加，血清IGF-I、IGFBP-3和瘦素浓度高于对照组。可以推测，这些变化可能会在以后的生活中加剧动脉粥样硬化进程。
