Abstract: Objective To analyze the changes in insulin sensitivity of small for gestational age (SGA) and the effect of different feeding for SGA on insulin sensitivity. Methods SGA borns in Peking University Third Hospital obstetrics in June 2011 to June 2014 were collected,for SGA group.Appropriate for gestational age (AGA) borns in the same period and in the same hospital were named as normal control (NC) group.All the subjects were enrolled into the Child Health Care Center to follow-up,examining physical measurements,measuring fasting blood glucose and insulin levels.Then on the basis of the formula,insulin resistance index (IRI) was calculated.According to different feeding within four months after birth,they were divided into breastfeeding group,artificial feeding group and the mixed feeding group.Then according to whether IRI of SGA group was higher than the median of the NC group,SGA was divided into two groups,non insulin sensitive group and insulin sensitive group. Results The growth rate of SGA was faster than that of normal weight infant,but had been unable to catch up with AGA in infant period.By the end of infancy,IRI value of SGA was significantly higher than that of NC group (t=3.715,P<0.05).Insulin sensitivity of SGA with breastfeeding was higher than that of the artificial feeding and mixed feeding(χ²=7.02,P<0.05). Conclusions The growth rate of SGA is faster than that of normal weight infant,but is unable to catch up with normal weight infant.SGA shows differences in insulin sensitivity at the end of infant period.The different feeding at early postnatal period may have some impact on insulin sensitivity of SGA.

Key words: small for gestational age, early feeding, insulin sensitivity

摘要： 目的 分析小于胎龄儿婴儿期胰岛素敏感性的变化及早期不同喂养方式对其胰岛素敏感性的影响,为临床上对小于胎龄儿(SGA)早期营养干预提供了依据和线索。方法 收集2011年6月-2014年6月在北京大学第三医院产科出生的小于胎龄儿为SGA组,正常对照(NC)组为同期同一家医院出生的健康适于胎龄儿(AGA)。两组新生儿进入本院儿童保健中心随访,进行常规体格测量,以及空腹血浆血糖(FPG)和空腹血清胰岛素(FINS)水平的测定,根据公式计算胰岛素抵抗指数(IRI)。根据生后4个月内的喂养方式不同,分为母乳喂养组、人工喂养组和混合喂养组,然后根据SGA组的IRI是否高于NC组的中位数将SGA又分为对胰岛素不敏感和对胰岛素敏感两组。结果 SGA组在1岁内生长发育速度快于NC组,但在1岁时仍未能追赶上NC组。在1岁时,SGA组婴儿的IRI值显著高于NC组(t=3.715,P<0.05)。生后早期母乳喂养较人工喂养和混合喂养的SGA胰岛素敏感性更高(χ²=7.02,P<0.05)。结论 SGA在婴儿期生长发育速度快于正常体重儿,但未能追赶上正常体重儿。SGA在婴儿期末已经表现出胰岛素敏感性的差异。生后早期喂养方式不同对SGA的胰岛素敏感性可能有一定的影响。