不同类型足月小于胎龄儿0~24月龄生长轨迹的回顾性纵向研究

Retrospective longitudinal study on growth trajectories from birth to 24 months in different subtypes of term small-for-gestational-age infants

摘要

目的 比较不同类型足月小于胎龄儿(SGA)0~24月龄生长轨迹差异,为社区个性化生长管理提供依据。方法 采用回顾性纵向研究设计,从广州市妇幼保健信息系统纳入2022年3月—2023年8月出生并在市桥街社区卫生服务中心完成规定月龄随访的241名足月SGA儿童。按出生体重和身长是否低于同性别、同胎龄第10百分位数(P₁₀)分为SGA1组(仅体重＜P₁₀,n=142)、SGA2组(仅身长＜P₁₀,n=50)和SGA3组(体重和身长均＜P₁₀,n=49);另按1∶2匹配482名适于胎龄儿(AGA)作为对照。计算年龄别体重Z评分(WAZ)和年龄别身长Z评分(HAZ),采用线性混合效应模型比较生长轨迹。结果 出生时,各SGA亚组的WAZ和HAZ均低于AGA组(F=238.660、244.809,P＜0.001)。各SGA亚组与时间的线性交互项均为正,而与时间²的交互项均为负,提示SGA与AGA之间的WAZ、HAZ差距在出生后缩小,SGA生长的衰减速度更慢。SGA2组追赶最明显:WAZ自3月龄起与AGA组差异无统计学意义;HAZ在12和18月龄时差异无统计学意义,但24月龄时差异再次出现(t=3.079,P=0.011)。24月龄时,SGA1组和SGA3组的WAZ、HAZ仍低于AGA组(P＜0.001),SGA2组WAZ与AGA组差异无统计学意义(P>0.05)。结论 足月SGA儿童出生后早期普遍出现追赶生长,但不同亚组的轨迹存在差异,且并非所有指标均在24月龄前达到AGA水平。社区应依据具体生长维度和动态轨迹开展分层监测。

Abstract

Objective To compare growth trajectories from birth to 24 months among different subtypes of term small-for-gestational-age infants, in order to provide a scientific basis for personalized growth management in community. Methods In this retrospective longitudinal study, 241 term SGA infants born between March 2022 and August 2023 and followed at the Shiqiao Community Health Service Center were classified as SGA1[birth weight <10th percentile (P₁₀) only, n=142], SGA2 (birth length <P₁₀ only, n=50), or SGA3 (both birth weight and length <P₁₀, n=49). A total of 482 appropriate-for-gestational-age (AGA) infants were matched at a 1∶2 ratio. Weight-for-age Z score (WAZ) and length-for-age Z score (HAZ) were analyzed using linear mixed-effects models to compare the growth trajectories. Results At birth, all SGA subgroups had lower WAZ and HAZ than the AGA group (F=238.660, 244.809, P<0.001). Positive subgroup-by-time and negative subgroup-by-time-squared interactions indicated that the gaps narrowed early after birth but SGA infants showed a slower decline in growth trajectory. Catch-up was most obvious in SGA2: WAZ did not differ significantly from AGA from 3 months onward; HAZ did not differ at 12 or 18 months old but was lower again at 24 months old (t=3.079, P=0.011). At 24 months, WAZ and HAZ remained lower in SGA1 and SGA3 (P<0.001), whereas WAZ in SGA2 did not differ from AGA (P＞0.05). Conclusions Term SGA infants generally show early catch-up growth, but trajectories differ across different subgroups and not all growth indicators reach AGA levels by 24 months old. Stratified growth monitoring should consider both the affected anthropometric dimension and the longitudinal trajectory.

关键词

足月小于胎龄儿 / 追赶生长 / 生长轨迹 / 线性混合效应模型

Key words

term small-for-gestational-age infants / catch-up growth / growth trajectory / linear mixed-effects model

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