目的 研究宫内发育迟缓（intrauterine growth retardation，IUGR）儿出生后6月免疫功能和追赶生长之间的关系，探讨“发育程序化”途径对机体免疫功能的影响程度。方法 选择2010年3~12月符合纳入和排除标准并且临床均诊断为IUGR的孕晚期孕妇60例，正常对照组孕妇20例。记录妊娠结局，随访出生儿童至6月龄，每月进行系统化的儿童保健，测量体质量、身长，并采用Z评分法评估儿童的生长发育偏离状况。在6月龄时采集外周静脉血，用流式细胞检测技术检测T淋巴细胞亚群CD3、CD4、CD8及B淋巴细胞，免疫比浊法检测IgG、IgM、IgA、C3、C4，分析宫内和宫外的追赶生长情况与免疫功能指标的关系。结果 IUGR组中小于胎龄儿（small for gestational age，SGA）的发生率为27.27%，新生儿并发症的发生率为29.09%。IUGR组新生儿的出生体质量、身长均低于对照组（\P<0.05）。随访至出生后6月，在矫正胎龄后，IUGR组男童出生体质量、1月龄体质量低于对照组，0～6月龄的身高低于对照组；IUGR组女童出生体质量，1、3、4、6月龄体质量低于对照组，出生身长、3~6月龄身长低于对照组，差异均有统计学意义（\P<0.05）。通过对追赶生长与免疫功能指标关系的分析发现，宫内无追赶生长组B淋巴细胞的比例低于宫内即出现追赶生长的IUGR儿童，差异有统计学意义（\P<0.05）。宫外未出现追赶生长儿童的B淋巴细胞数量高于正常对照组，差异有统计学意义（\P<0.05），但IgG水平低于正常对照组，而出现了追赶生长儿童的B淋巴细胞数量与正常对照组差异无统计学意义（\P>0.05)。结论 宫内和宫外未出现追赶生长的IUGR组婴儿到6月龄时部分免疫功能仍未恢复正常，但“发育程序化”的假说仍需要更大样本量及长期的队列研究证实。
英文摘要:
Objective To explore the influence of “developmental programming” on immunity function and the correlation between immunologic changes and physical growth. Methods Sixty singleton pregnancies with intrauterine growth retardation (IUGR) and twenty normal pregnant women were enrolled in this study at their third trimester of pregnancy. Birth weight, birth length, mode of delivery, complication of newborn were measured and/or recorded at the moment of delivery. Physical development of the infants was measured every month up to six months old using weight and length as indicators. The deviation of physical growth was evaluated by \Z score. Blood samples were taken from the infants at the sixth month. Lymphocyte subpopulations were analyzed using flow cytometry. Humoral immunity were measured using immunoturbidimetry. Results About 27.27% and 29.09% of IUGR infants were found to have small for gestational age (SGA) and neonatal complications. They had lower birth body masses and birth lengths than those of controls （\P<0.05）. After correcting for gestational age, the IUGR boys had lower body masses at birth and one months old, as well as lower lengths at 0-6 months compared with the controls. The IUGR girls had lower weights at 0, 1, 3, 4, and 6 months, as well as lower lengths at 0, 3, 4, 5, and 6 months. The IUGR infants without intrauterine-catch-up growth had lower proportion of B lymphocyte than those with intrauterine-catch-up growth （\P<0.05）. The IUGR infants without extrauterine-catch-up growth had higher numbers of B lymphocyte and lower IgG than those of normal controls（\P<0.05）.Conclusion IUGR infants without intrauterine-catch-up and extrauterine-catch-up have impaired immunity function. The theory of “development program” needs proof of studies with a large sample size and long-term follow-up.
