小于胎龄儿的诊断和治疗

©1994-2009ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.:,,,,,,,,(APPES),,50/,4,,[e-mail],(,100045)DiagnosisandTreatmentofSmallforGestitionalAgeGONGChun-xiu,HUANGHui(DepartmentofEndocrinology,BeijingChildrensHospitalAffiliatedtoCapitalMedicalUniversity,Beijing100045,China):(SGA)102s,SGA,SGA,2009,24(20):1622-1624:;;;:R725.8:A:1003-515X(2009)20-1622-03(SGA)10aSGA10-2sSGA35[123]SGA-2s,2.3%1010%SGA,SGA,715%[4]SGA(IUGR),IUGR,IUGRSGASGAIUGR1SGA1.1SGA,,(1):20%30%[5],,,,,,,,(2):70%80%[5],,,,(),,,,,,50%,1.2SGASGASGA(SGAL),SGA(SGAW),SGA(SGAL,W)[6]SGA,,[7],SGA2SGA2.1SGA,(AGA)[8],[9],[10211]SGA[12]SGASGA,2.2SGA,SGA612,285%90%SGA,15%SGA,50%,SGA,6[13]SGA2,1,SGA[14215]2.3SGA(IR)2(T2DM)AGA[16],T2DM(MS)SGA[17],,IRHales[18],:(),(),,,,,IRIR22612420200910JApplClinPediatr,Vol.24No.20,Oct.2009©1994-2009ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[19]Stono[20]SGA1,SGASGAAGA,SGASGAAGA,IR1,Ibanez[21]SGA,IR,IR[22223]IR(GH)GH221(IGF21),GHIGF21,IGF2123(IGFBP23)GHSGAIGF21IGFBP23,IGF21IGFBP23,IGF21IGFBP23[24]GHSGAIR[25]GH3(PI3K),,Akt/B(PKB)PI3K,SGAP2Akt,,GHJAK2,Akt,GHIR[26]IRMS,T2DM[27]296,32ARTrp64ArgSGA(ACE)I/D3d[28]2,ACEDD32ARArg64,,IR3SGASGA,,SGA,,,,,SGA,,,SGA,,[29]623,SGA,SGAIRT2DM,,SGA,IR,IGF21IGFBP23,IR,,,;,GHGH,IGF21IGFBP23,[14],[13],SGA,2,3,GHSGA:(1)-2s;(2)-2.5s;(3)4;(4)0s[30](FDA)200172SGAGHGH,,FDA0.48mg/(kg)[0.2IU/(kgd),0.067mg/(kgd)],26a[31],0.240.48mg/(kg)[0.71.4IU/(kg)]IGF21IGFBP23,IGF21[30]GH,,GH,1GH,GH,GH,GHSGA,,GH,[32]GH,SGA[33]SGA,,[34],(AI),[35]GHGHSGAIFG21IGFBP23,,,IR[36]GHHb,[37][38239]:[1]JiangZD,BrosiDM,WangJ,etal.Brainstemauditory-evokedrespon232612420200910JApplClinPediatr,Vol.24No.20,Oct.2009©1994-2009ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[J].ActaPaediatr,2004,93(1):76-81.[2]McCowanLM,HardingJE,StewartAW.CustomizedbirthweightcentilespredictSGApregnancieswithperinatalmorbidity[J].BJOG,2005,112(8):1026-1033.[3]SotoN,BazaesRA,PeÌaV,etal.Insulinsensitivityandsecretionarere2latedtocatch-upgrowthinsmall-for-gestational-ageinfantsatage1year:Resultsfromaprospectivecohort[J].JClinEndocrinolMetab,2003,88(8):3645-3650.[4],.[M].2.:,2006:59-61.[5],,,.SGA[J].,2003,18(7):408-410.[6]VerkauskieneR,AlbertssonWK,NiklassonA.VaritioninsizeatbirthininfantsbornsmallforgestationalageinLithuania[J].ActaPaediatr,2002,91(3):329-334.[7],.[M].:,1989:877-886.[8]MarestadY,VikT,AhlstenG,etal.Small-for-gestational-age(SGA)infantsbornatterm:Growthanddevelopmentduringthefirstyearoflife[J].ActaObstetGynecolScand,1997,165(suppl):93-101.[9]McCartonCM,WallaceIF,DivonM,etal.Cognitiveandneurologicde2velopmentofthepremature,smallforgestationalageinfantthroughage6:Comparisonbybirthweightandgestationalage[J].Pediatrics,1996,98(6pt1):1167-1178.[10]LarroqueB,BertraisS,CzernichowP,etal.Schooldifficultiesin20-year-oldswhowerebornsmallforgestationalageatterminaregionalcohortstudy[J].Pediatrics,2001,108(1):111-115.[11]StraussRS.Adultfunctionaloutcomeofthosebornsmallforgestationalage:Twenty-six-yearfollow-upofthe1970BritishBirthCohort[J].JAMA,2000,283(5):625-632.[12]LundgrenEM,CnattingiusS,JonssonB,etal.Intellectualandpsycho2logicalperformanceinmalesbornsmallforgestationalagewithandwithoutcatch-upgrowth[J].PediatrRes,2001,50(1):91-96.[13]PaulS,PaulC,IeuanH,etal.Smallforgestationalage:Shortstatureandbeyond[J].EndcrineRev2007,28(2):219-251.[14],,,.SGA3[J].,2008,29(3):200-202.[15],,,.SGA[J].,2007,15(1):48-50.[16],.SGA[J].,2006,21(2):117-119.[17]KathrynB,KenKL,AmandaL,etal.Growthandgrowthhormoneinchildrenbornsmallforgestationalage[J].GrowthHormIGFRes,2004,14(supplA):3-6.[18]HalesCN,BarkerDJ,ClarkPM,etal.Fetalandinfnatgrowthandim2pairedglucosetoleranceatage64[J].BMJ,1991,303(6809):1474-1475.[19]ErikssonJG,ForsenT,TuomilehtoJ,etal.Catch-upgrowthinchild2hoodanddeathfromcoronaryheartdisease:Longitudinalstudy[J].BMJ,1999,318(7181):427-431.[20]StonoN,BazaesRA,PenaV,etal.Insulinsenseitivityandsecretionarerelatedtocatch-upgrowthinsmall-for-gestational-ageinfantsatage1year:Resultsfromaprospectivecohort[J].ClinEndocrinolMetab,2003,88(8):3645-3650.[21]IbanezL,OngK,DungerDB,etal.Earlydevelopmentofadiposityandinsulinresistanceaftercatch-upweightgaininsmall-for-gestatio2nal-agechildren[J].JClinEndocrinolMetab,2006,91(6):2153-2158.[22]IbanezL,JimenezR,deZegherF.Earlypuberty-menarcheafterpre2cociouspubarche:Relationtoprenatalgrowth[J].Pediatrics,2006,117(1):117-121.[23]deZegherF,IbanezL.Prenatalgrowthrestraintfollowedbycatch-upofweight:Ahyperinsulinemicpathwaytopolycysticovarysyndrome[J].FertilSteril,2006,86(suppl1):4-5.[24]HemachandraAH,HowardsPP,SchistermanEF,etal.Interactionbe2tweenbirthweightandpostnatalgrowthdoesnotincreaseriskforhighbloodpressureatage7years:ResultsfromtheUnitedStatesCollabora2tivePerinatalProject[J].PediatrRes,2005,58:1102.[25]WoodsKA,vanHelvointM,OngKK,etal.Thesomatotropicaxisinshortchildrenbornsmallforgestationalage:Relationtoin