目的 了解小于胎龄儿(small for gestational age neonates,SGA)早期血脂及脂蛋白代谢特点。方法 选择无严重并发症新生SGA 47例为研究对象,以45例足月适于胎龄儿(adequate for gestational age,AGA)作为对照组。于出生后12 h内静脉采血,测定血浆总胆固醇(total cholesterol,TC)、甘油三脂(triglyceride,TG),低密度脂蛋白胆固醇(low-density lipoprotein cholesterols,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterols,HDL-C)、载脂蛋白(apolipoproteins,apo)A1及apo-B水平,计算LDL-C/HDL-C及apo-B/apo-A1比值;并进一步将SGA根据是否足月、宫内发育迟缓程度(出生体重位于同胎龄平均体重P₃以下为SGA1组,P₃~P₁₀之间为SGA2组)及性别进行分组,比较上述指标的水平。结果 与对照组比较, SGA患儿具有高的TC(2.41±0.61 vs 2.11±0.78,P<0.05)、LDL-C(0.90±0.44 vs 0.71±0.42,P<0.05)和apo-B(0.40±0.22 vs 0.29±0.15,P<0.01)浓度,及高的LDL-C/HDL-C(1.31±1.29 vs 0.82±0.46,P<0.05)、apo-B/apo-A1(0.60±0.35 vs 0.40±0.19,P<0.01)比值;SGA1组比SGA2组具有低的TC、HDL-C及apoA1水平,而具有高的apo-B/apo-A1比值(P<0.01或<0.05);早产SGA患儿比足月SGA患儿具有低的TG水平(P<0.05);性别对SGA血脂及脂蛋白水平没有影响。结论 不良的宫内环境使SGA早期可出现脂质代谢异常,宫内发育迟缓越严重脂质代谢异常越明显,SGA远期可能更易出现心血管疾病;早产SGA血浆TG水平低于足月SGA,可能与新生儿成熟度相关。

Objective To determine the concentrations of serum lipids and lipoprotein of small for gestational age neonates(SGA). Methods 47 SGA neonates were enrolled in this study,45 term infant of appropriate for gestational age(AGA) selected randomly were used as the control.Vein blood was collected within 12 hours after birth for biochemical analysis,including total cholesterol (TC),high-density lipoproteins cholesterols (HDL-C) low-density lipoproteins cholesterols (LDL-C),triglyceride(TG),LDL-C/HDL-C,apolipoproteins (apo)A1,apoB and apoB/apoA1.Impact of gestational age (preterm and term),degree of intrauterine growth retardation ( birth weight below the 3th percentile(SGA 1) and between the 3th and 10th percentile(SGA 2) of the local sex-specific distribution for gestational age) and gender (male and female) on the values of SGA were compared further. Results TC(2.41±0.61 vs 2.11±0.78,P<0.05)、LDL-C(0.90±0.44 vs 0.71±0.42,P<0.05)and apo-B(0.40±0.22 vs 0.29±0.15,P<0.01)concentrations,and atherogenic indices,including LDL-C/HDL-C(1.31±1.29 vs 0.82±0.46,P<0.05)and apo-B/apo-A1(0.60±0.35 vs 0.40±0.19,P<0.01)ratios,were found to be higher in the SGA compared to the control group.The SGA 1 neonates had significantly lower TC、HDL-C and apoA1 concentrations,as well as higher apo-B/apo-A1 ratio than the SGA 2 group ( P<0.01 or P<0.05).TG value was lower in preterm than in full-term SGA newborns( P<0.05).No gender difference was observed among SGA newborns. Conclusion SGA neonates displayed profiles of less favorable lipid metabolism in the early postnatal period and more severe degree of intrauterine growth retardation may be associated with higher degrees of lipid disorders,SGA has been shown to be a risk factor for developing cardiovascular disease later in life.Lower TG values in preterm SGA newborns maybe related to their fetal maturity.