Department of Molecular Medicine and Surgery, Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Acta Paediatr. 2012 Dec;101(12):1217-24. doi: 10.1111/apa.12005. Epub 2012 Sep 17.
To evaluate the impact of prenatal or postnatal compromised environment on glucose homoeostasis in children born preterm and appropriate for gestational age or small for gestational age (SGA) at term.
Seventy-seven children (median 9.9 years, range 8.5-10) born at Karolinska Hospital were allocated to three groups: 21 subjects born before 30 weeks of gestational age (preterm), 26 SGA at term and 30 at term with appropriate birth weight (control). Anthropometric measurements were taken, and fasting blood samples for haemoglobin A1c, glucose, insulin, IGFBP-1, IGF-1 and lipid profile were taken. Glucose, insulin and IGFBP-1 samples were taken at 0, 30 and 120 min during an oral glucose tolerance test (OGTT).
Subjects born preterm or SGA were shorter and thinner compared with Controls. After adjustment for body mass index (BMI), the SGA group had higher basal insulin levels (p = 0.029), higher homoeostasis model assessment-insulin resistance (p = 0.012) and lower whole-body insulin sensitivity index (p = 0.007) than Controls. IGFBP-1 decrease during OGTT was attenuated in the Preterm group compared with the Control (p = 0.045) and SGA groups (p = 0.007).
The higher fasting insulin level in the SGA children, adjusted for BMI, could indicate peripheral insulin resistance. Preterm born children had reduced suppression of IGFBP-1 during OGTT, suggesting hepatic insulin resistance.
评估产前或产后环境受损对足月出生且胎龄适当或小于胎龄（SGA）的早产儿和足月儿的血糖稳态的影响。
将卡罗林斯卡医院的 77 名儿童（中位数 9.9 岁，范围 8.5-10 岁）分为三组：21 名出生于 30 周前（早产儿）、26 名足月出生的 SGA 和 30 名胎龄适当且出生体重适当（对照组）的儿童。进行体格测量，并采集空腹血样，用于检测糖化血红蛋白 A1c、血糖、胰岛素、IGFBP-1、IGF-1 和血脂谱。在口服葡萄糖耐量试验（OGTT）中，在 0、30 和 120 分钟时采集葡萄糖、胰岛素和 IGFBP-1 样本。
与对照组相比，早产儿或 SGA 出生的儿童身高和体重更矮更瘦。在校正体重指数（BMI）后，SGA 组的基础胰岛素水平更高（p = 0.029），稳态模型评估-胰岛素抵抗（HOMA-IR）更高（p = 0.012），全身胰岛素敏感性指数（ISI）更低（p = 0.007）。与对照组和 SGA 组相比，OGTT 期间 IGFBP-1 的下降在早产儿组中受到抑制（p = 0.045）。
SGA 儿童的空腹胰岛素水平更高，即使在校正 BMI 后，也可能表明存在外周胰岛素抵抗。早产儿在 OGTT 期间 IGFBP-1 的抑制作用减弱，提示存在肝胰岛素抵抗。
