足月匀称型及非匀称型小于胎龄儿生长发育比较

摘要

目的 分析足月匀称型小于胎龄儿(FSGR)及足月非匀称型小于胎龄儿(FAGR)的体格发育差异.方法 2011年4月至2011年10月上海交通大学附属儿童医院依托上海市妇幼卫生三级预防网络对上海市18个市辖区内所有不满6周岁的常住儿童展开普查,回顾性收集体格检查数据,利用上海市首次小于胎龄儿(SGA)普查数据,以同胎龄、同性别出生头围/出生体重的第10百分位(P10)为划分标准对足月SGA儿童进行分组.结果 本研究共纳入足月SGA 10 188例,其中FAGR 8049例,FSGR 2139例.至3周岁,二者体重(t=-3.412,P=0.001)及胸围(t=-2.526,P=0.012)差异在3周岁时仍显著.6月龄前,FAGR体重(t=6.272,P＜0.001)、身长(t=9.143,P＜0.001)、头围(t=6.063,P＜0.001)及胸围(t=6.617,P＜0.001)的增幅均大于FSGR,6月龄后二者差异无统计学意义.2周岁前,FSGR的体重指数显著高于FAGR,处于超重危险的比例亦显著增高.两类足月SGA的体重、身高、头围及胸围均落后于正常儿童,FAGR的体格发育落后于FSGR.结论 FSGR及FAGR都未追赶至正常儿童发育水平,头围落后最为显著.虽然FAGR的体格发育落后于FSGR,其追赶生长模式更为理想.FSGR处于超重危险的比例显著高于FAGR.%Objective To find the difference in growth and development of children between full-term symmetric growth restriction (FSGR) and full-term asymmetric growth restriction(FAGR) through a general investigation of children born small for gestational age in Shanghai.Methods This general investigation covered all children under 6 years old in Shanghai.Data on growth were retrospectively obtained from medical records.The P10 of birth head circumference/birthweight of the same gestational age and gender was used to distinguish FSGR and FAGR.Results The sample contained 10 188 full-term SGA children among whom 8049 were FAGR and 2139 were FSGR.Up to 3 years old,both FSGR and FAGR failed to catch up in weight,height,head circumference and chest circumference.Growth restriction in FAGR was more serious.Significant difference could be seen in weight (t =-3.412,P =0.001) and chest circumference (t =-2.526,P =0.012) between FSGR and FAGR at 3 years old.Regarding growth speed,the growth rate of weight (t =6.272,P ＜ 0.001),height (t =9.143,P ＜0.001),head circumference (t =6.063,P ＜ 0.001) and chest circunference (t =6.617,P ＜ 0.001) were higher in FAGR 6 months after birth,while there was no difference after that.The BMI of FAGR was significantly lower than FSGR before 2 years old.The proportion of children in danger of being overweight was significantly higher in FSGR (P ＜ 0.001).Conclusion Both FSGR and FAGR experience catch-up growth after birth,but not enough to catch up with normal children at 3 years old,especially in head circumference.In spite of severer growth restriction,the cath-up growth model of FAGR is superior to FSGR.The proportion of children in danger of being overweight is significantly higher in FSGR.