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宫内和宫外生长对极低出生体重儿新生儿期骨矿物质密度和含量的影响。

Impact of intra- and extrauterine growth on bone mineral density and content in the neonatal period of very-low-birth-weight infants.

作者信息

Li Jingang, Funato Masahisa, Tamai Hiroshi, Wada Hiroshi, Nishihara Masato, Morita Takashi, Miller Suzanne L, Egashira Kayo

机构信息

Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC Australia.

Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.

出版信息

Early Hum Dev. 2016 Jan;92:1-6. doi: 10.1016/j.earlhumdev.2015.10.020. Epub 2015 Nov 24.

DOI:10.1016/j.earlhumdev.2015.10.020

PMID:26619067

Abstract

BACKGROUND

Very-low-birthweight infants (VLBWIs) are at high risk for suboptimal bone mineral density (BMD) and bone mineral content (BMC). Small-for-gestational-age (SGA) status also causes reduced bone mineralization in full-term infants. However, the impact of intrauterine and postnatal extrauterine growth on BMD and BMC in VLBWIs is inconclusive.

METHODS

We retrospectively investigated n=68 VLBWIs, comprising 45 appropriate-for-gestational-age (AGA) and 23 SGA infants who underwent lumbar spine dual-energy X-ray absorptiometry at term-equivalent age.

RESULTS

BMD and BMC did not differ between AGA and SGA VLBWIs. Subgroup analyses of infants with birthweight<1000 g vs 1000-1500 g, and GA<27 weeks vs ≥ 27 weeks also showed no differences in BMD and BMC between AGA and SGA infants. In contrast, infants with extrauterine growth restriction (EUGR) showed significantly lower values than those without (BMD: 0.124 ± 0.023 vs 0.141 ± 0.032 g/cm(2), P=0.02; BMC: 0.80 ± 0.26 vs 0.94 ± 0.23 g, P=0.04). There were no differences between AGA and SGA infants with EUGR. However, in the AGA cohort, infants with EUGR showed significantly lower values than those without (BMD: 0.121 ± 0.022; 0.141 ± 0.03 g/cm(2), P=0.02; BMC: 0.73 ± 0.23 vs 0.94 ± 0.23 g, P=0.005). Multiple regression analyses showed GA, weight and head circumference at birth, and weight percentile at term correlated with term BMD. Conversely, only weight percentile at term significantly correlated with term BMC.

CONCLUSION

EUGR, rather than IUGR, is a risk factor for reduced BMD and BMC in the neonatal period in VLBWIs.

摘要

背景

极低出生体重儿（VLBWIs）骨矿物质密度（BMD）和骨矿物质含量（BMC）处于次优水平的风险较高。小于胎龄儿（SGA）状态也会导致足月儿骨矿化减少。然而，宫内和出生后宫外生长对VLBWIs的BMD和BMC的影响尚无定论。

方法

我们回顾性研究了68例VLBWIs，其中包括45例适于胎龄儿（AGA）和23例SGA婴儿，这些婴儿在足月相当年龄时接受了腰椎双能X线吸收法检查。

结果

AGA和SGA的VLBWIs之间的BMD和BMC没有差异。对出生体重<1000g与1000-1500g以及胎龄<27周与≥27周的婴儿进行亚组分析，结果显示AGA和SGA婴儿之间的BMD和BMC也没有差异。相反，宫外生长受限（EUGR）的婴儿的值显著低于无宫外生长受限的婴儿（BMD：0.124±0.023 vs 0.141±0.032g/cm²，P=0.02；BMC：0.80±0.26 vs 0.94±0.23g，P=0.04）。EUGR的AGA和SGA婴儿之间没有差异。然而，在AGA队列中，EUGR的婴儿的值显著低于无EUGR的婴儿（BMD：0.121±0.022；0.141±0.03g/cm²，P=0.02；BMC：0.73±0.23 vs 0.94±0.23g，P=0.005）。多元回归分析显示，出生时的胎龄、体重和头围以及足月时的体重百分位数与足月时的BMD相关。相反，只有足月时的体重百分位数与足月时的BMC显著相关。