Clinical Study On Intrauterine Growth Restriction And Abnormal Glucose And Lipid Metabolism

Background: With the opening of the second child policy in our country,the number of elderly pregnant women increased significantly,and the incidence of neonatal diseases associated with pregnancy is also increasing.Intrauterine growth restriction as a common clinical problem during the perinatal period,because often accompanied by perinatal or long-term adverse outcomes,more and more attention from the pediatrician and obstetrician.Although studies have found that IUGR can reduce the incidence of neonatal respiratory distress syndrome(NRDS)incidence rate;but in recent years,more proof of animal experiment and clinical IUGR are risk factors of adult obesity,hypertension,diabetes,coronary heart disease and other metabolic diseases.In clinic diagnosis and treatment work,because of the lack of IUGR diagnostic conditions,the pediatrician use SGA instead of IUGR.SGA,who's birth weight lower than the tenth percentile for the same gestational ageObjectives:1.To investigate the SGA blood alpha-L-fucosidase(AFU)level and its correlation with glucose and lipid metabolism.2.To investigate the role of PPAR? and TR4 in the mechanism of glucose and lipid metabolism in adult rats with IUGR.Methods:1.From August 2013 to September 2016,125 SGA infants and 128 appropriate for gestational age(AGA)neonates onset wet lung which treated in our hospital were included as study subjects in this case control study.The serum level of AFU,blood glucose and lipid level were detected within 24 hours after birth and extracted from the clinical records.These test outcomes were compared between the two groups and between different subgroups of SGA infants.In addition,the relationship between serum AFU level and blood glucose and lipid level was analyzed in SGA infants.2?IUGR rat model was prepared,and were used as the Research carrier.At 12 weeks after delivery,test the adult rats' s blood glucose and lipids,liver lipids and the expression of PPAR? and TR4 gene and protein,who related to glucose and lipid metabolism.To explore the mechanism of Metabolic Diseases(MS)in the IUGR population.Results:1.Shown by the demographic characteristics of children in two groups:SGA group compared with the control group,the admission age(4.4 + 5.3 vs 6+ 6.1,P < 0.05),birth weight(2018 + 438 vs 3166 + 490,P < 0.0001)were less than the control group,and the mother with pregnancy induced hypertension(24% vs 6.3%,P < 0.0001),abnormal amniotic fluid(37.7% vs 18.3%,P <0.001)and children need delivery room recovery(22.4% vs 4.7%,P < 0.0001)the incidence rate increased significantly compared with the control group.The biochemical analysis shows : AFU(10.48 + 3.73 vs 11.89 + 3.43,P < 0.005),HDL-C(0.79 + 0.35 vs 0.98 + 0.31,P < 0.0001),Apo-A(0.60 + 0.22 vs 0.65 +0.17,P < 0.005)and lipoprotein a(11.80 vs 15.60,P < 0.0005),SGA were significantly lower compared with control group;while the TG was significantly higher than the control group(0.68 + 0.40 vs 0.44 + 0.27,P <0.0001).The correlation analysis shows: SGA blood AFU and blood glucose levels in newborn infants(r=0.18,P<0.05),TC(r=0.33,P<0.0001),HDL-c(r=0.43,P<0.0001),LDL-c(r=0.22,P<0.005)and Apo-A(r=0.30,P<0.001)are positively related;and negatively correlated with TG(r=-0.19,P<0.05).Furthermore,the serum level of AFU was lower in SGA infants with birthweight < 3rd percentile than those without(10.11±3.59 vs 12.25±4.03,P <0.05).2.The blood glucose level in the IUGR group was higher than that in the AGA group at 12 weeks,and the glucose tolerance and insulin tolerance test showed glucose intolerance and insulin resistance.Blood biochemical test results showed that: compared with AGA rats,the IUGR rats had lower level of HDL-c(0.79 + 0.35 vs 0.98 + 0.31,P <0.0001),apolipoprotein A(0.60 + 0.22 vs 0.65 + 0.17,P <0.05),lipoprotein a(11.80 vs 15.60,P <0.0001),while a higher level of TG(0.68 + 0.40 vs 0.44 + 0.27 P,<0.0001);but no statistically significant difference of TC,LDL-c and apolipoprotein B.Liver tissue examination: At 12 weeks after birth,the biochemical test results of liver tissue showed elevated TG of IUGR rats(3.77 + 0.37 + 0.35 vs2.56,P <0.01),but there was no significant difference in TC(P =0.91)in two groups.IUGR rats 12 weeks after TR4 m RNA expression had no significant difference(0.92 + 0.22 vs 1.12 + 0.18 P,=0.12);but PPAR? m RNA expression was significantly increased(31.48 + 15.28 vs 1.18 + 0.16 P,<0.0001),and the corresponding TR4 protein(0.38 + 0.35 + 0.02 vs 0.04,P =0.08)was no significant difference between.However,the expression of PPAR? protein(0.21 + + 0.02 vs + + 0.01,P <0.0001)increased.Conclusion:1.Early neonatal blood AFU can indirectly reflect the intrauterine growth state.AFU levels in children with SGA was related to blood lipid metabolism level.It can be used as a reference index to evaluate fetal growth.2.IUGR of adult rats appeared abnormal glucose and lipid metabolism,gene and protein expression which regulated the glucose and lipid metabolism also changed.Expression of PPAR? gene and protein increased while TR4 did not change significantly.