Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Horm Res Paediatr. 2020;93(7-8):453-459. doi: 10.1159/000512784. Epub 2021 Feb 3.
Besides programming of the hypothalamic-pituitary-adrenal (HPA) axis, changes in the activity of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) could contribute to the later metabolic and cardiovascular consequences of preterm birth.
We compared serum cortisol, cortisone, and cortisol/cortisone ratio in early childhood in very-low-birthweight (VLBW) infants and term appropriate for gestational age (AGA) born infants.
We included 41 VLBW infants, participating in the randomized controlled Neonatal Insulin Replacement Therapy in Europe trial, and 64 term AGA-born infants. Cortisol and cortisone were measured in blood samples taken at 6 months and 2 years corrected age (VLBW children) and at 3 months and 1 and 2 years (term children). At 2 years of (corrected) age (HDL) cholesterol, triglycerides, glucose, and insulin were also measured.
During the first 2 years of life, cortisol/cortisone ratio is higher in VLBW children compared to term children. In the total group of children, cortisol/cortisone ratio is positively related to triglycerides at 2 years of (corrected) age. In VLBW children, over the first 2 years of life both cortisol and cortisone are higher in the early-insulin group compared to the standard care group.
In VLBW infants, lower 11β-HSD2 activity probably contributes to the long-term metabolic and cardiovascular risks. In VLBW infants, early insulin treatment could affect programming of the HPA axis, resulting in higher cortisol and cortisone levels during early childhood.
除了下丘脑-垂体-肾上腺（HPA）轴的编程外，11β-羟类固醇脱氢酶类型 2（11β-HSD2）活性的变化可能导致早产儿后期代谢和心血管并发症。
我们比较了极低出生体重（VLBW）婴儿和足月适当胎龄（AGA）出生婴儿在幼儿期的血清皮质醇、皮质酮和皮质醇/皮质酮比值。
我们纳入了 41 名参与欧洲新生儿胰岛素替代治疗随机对照试验的 VLBW 婴儿和 64 名足月 AGA 出生的婴儿。在 6 个月和 2 岁校正年龄（VLBW 儿童）和 3 个月、1 岁和 2 岁（足月儿童）时采集血样测量皮质醇和皮质酮。在 2 岁（校正）年龄时还测量了高密度脂蛋白（HDL）胆固醇、甘油三酯、葡萄糖和胰岛素。
在生命的头 2 年，VLBW 儿童的皮质醇/皮质酮比值高于足月儿童。在所有儿童中，皮质醇/皮质酮比值与 2 岁（校正）年龄的甘油三酯呈正相关。在 VLBW 儿童中，在生命的头 2 年，早期胰岛素组的皮质醇和皮质酮均高于标准治疗组。
在 VLBW 婴儿中，较低的 11β-HSD2 活性可能导致长期代谢和心血管风险。在 VLBW 婴儿中，早期胰岛素治疗可能会影响 HPA 轴的编程，导致幼儿期皮质醇和皮质酮水平升高。
