作者：Scratch SE 等西安交通大学医学院第二附属医院小儿内科肖延风

澳大利亚维多利亚皇家儿童医院

据《J Clin Endocrinol Metab》2015 年 7 月报道

原标题：High Postnatal Growth Hormone Levels Are Related to Cognitive Deficits in a Group of Children Born Very Preterm.

中文译文

生长激素（GH）对脑部发育是否有影响，尤其是对于极度早产儿（VP，< 30周），临床医生对此知之甚少。有医生认为，早产儿在出生后第一天的 GH 水平要高于足月儿。VP 早产儿在儿童期会出现认知障碍，并且会出现弥散性脑结构异常。澳大利亚维多利亚皇家儿童医院默多克儿童研究所的 Scratch SE 等进行了一项研究，探讨 VP 早产儿出生后体内 GH 水平，以及该水平与 7 岁时的认知功能和脑容量之间的关系。

研究纳入了 83 例 VP 早产儿，在出生后 8 个时间点检测 GH 水平，并计算 2 周和 6 周的曲线下面积（AUC）。在 7 岁时进行神经内分泌学评估和脑部核磁共振成像检查。使用单变量和多变量回归模型分析 GH AUC 是否能够作为 7 岁时脑部神经发育的主要预测指标。

结果显示，在单变量模型分析中，GH 水平升高（2 周 AUC）与词语工作记忆（P = 0.04）和转移注意性任务（P = 0.01）降低相关。多变量模型分析显示同样结果。在对 6 周 AUC 分析后发现，工作记忆（P = 0.03）、即刻空间记忆（P = 0.02）和延迟空间记忆（P = 0.03）出现下降。对潜在混杂因素进行校正后发现，GH 水平升高与杏仁核体积增大相关（P = 0.002，2周 AUC；P = 0.03，6周 AUC）。

研究表明，VP 早产儿出生后 GH 水平升高与学龄时的脑部神经发育障碍可能具有潜在相关性。

CONTEXT AND OBJECTIVES

Little is known regarding the influence of GH on brain development, especially in infants born very preterm (VP;<30 weeks' gestation). Preterm infants are thought to have higher levels of GH in the first days of life compared with full-term infants. VP infants experience cognitive difficulties in childhood and have a diffuse pattern of structural brain abnormalities. This study aimed to explore the relationship between postnatal GH concentrations following VP birth and its association with cognitive functioning and brain volumes at age 7 years.

METHODS

Eighty-three infants born VP had GH concentrations measured at eight time points postnatally, and 2- and 6-week area under the curve (AUC) summary measures were calculated. Follow up at age 7 years included neuropsychological assessment and brain magnetic resonance imaging. Univariable and multivariable regression modeling were used where AUC for GH was the main predictor of neurodevelopmental outcome at age 7 years.

RESULTS

Univariable modeling revealed that higher GH levels (2-week AUC) were related to poorer performance on a verbal working memory (P = .04) and shifting attention task (P = .01). These relationships persisted on multivariable modeling and when the 6-week AUC was analyzed; working memory (P = .03), immediate spatial memory (P = .02), and delayed spatial memory (P = .03) deficits were found. Higher GH levels were also associated with larger amygdala volumes after adjustment for potential confounders (P = .002, 2-week AUC; P = .03, 6-week AUC).

CONCLUSIONS

Higher postnatal GH levels may potentially contribute to the documented neurodevelopmental abnormalities seen in children born VP at school age.