Rotteveel J, van Weissenbruch M M, Delemarre-Van de Waal H A
Department of Pediatrics and Institute for Clinical and Experimental Neurosciences, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
Eur J Endocrinol. 2008 Jun;158(6):899-904. doi: 10.1530/EJE-08-0152. Epub 2008 Apr 7.
Low birth weight and preterm birth are associated with growth delay as well as the development of insulin resistance. Insulin resistance is especially seen in subjects with catch-up growth. GH therapy induces growth in short subjects with low birth weight at term, but little is known about the long-term effects on insulin sensitivity. GH therapy is now also proposed for preterms that remain short.
We investigated insulin sensitivity using the gold standard hyperinsulinemic-euglycemic clamp technique in 10 young adult males born small for gestational age (SGA) who had been treated with GH during childhood (GH) in comparison with 15 males born preterm AGA (premAGA), 13 males born preterm SGA (premSGA), and 15 males born at term with normal birth weight (CON). Furthermore, we investigated the presence of the metabolic syndrome.
Insulin sensitivity was decreased in premAGA, premSGA, and GH subjects compared with CON males. The metabolic syndrome was not present in any of the groups.
Insulin sensitivity is decreased in GH-treated SGA born males as well as in preterm born males. With respect to the SGA subjects, whether the difference results from perinatal-, postnatal-, or GH therapy-related factors are not known. With respect to the preterm born subjects, close surveillance is needed when commencing GH therapy.
低出生体重和早产与生长发育迟缓以及胰岛素抵抗的发生有关。胰岛素抵抗在追赶生长的个体中尤为常见。生长激素（GH）治疗可促进足月低出生体重矮小个体的生长，但对胰岛素敏感性的长期影响知之甚少。目前也有人提议对仍身材矮小的早产儿使用GH治疗。
我们采用金标准的高胰岛素-正葡萄糖钳夹技术，对10名在儿童期接受过GH治疗的小于胎龄儿（SGA）成年男性（GH组）、15名适于胎龄的早产儿成年男性（早产适于胎龄儿组，premAGA）、13名小于胎龄的早产儿成年男性（早产小于胎龄儿组，premSGA）和15名足月正常出生体重成年男性（对照组，CON）的胰岛素敏感性进行了研究。此外，我们还调查了代谢综合征的存在情况。
与对照组男性相比，premAGA组、premSGA组和GH组的胰岛素敏感性均降低。所有组均未出现代谢综合征。
接受GH治疗的SGA出生男性以及早产出生男性的胰岛素敏感性均降低。对于SGA个体，尚不清楚这种差异是由围产期、出生后还是GH治疗相关因素导致的。对于早产出生个体，开始GH治疗时需要密切监测。
