小儿血脂紊乱发病的高危因素(2)
众多的研究均证实具有早发性心血管病家族史的儿童血脂水平与健康对照组相比具有显著增高的差异。国内胡氏等[6]对于54例早发性心血管病家族史的儿童进行血脂检测，发现与阴性家族史儿童相比，前者ApoAI水平显著偏低，而血清Lp(a)水平明显升高；向氏等[7]发现有早发性心血管病家族史儿童的血TG、TC、LDL-C、apoB100及Lp(a)的水平均显著高于无该病家族史的儿童，而HDL-C、ApoAI及apoE水平则显著偏低。因此NCEP将冠心病家族史作为冠心病发生的主要危险因素之一，建议对早发性心血管病家族史的儿童进行血脂筛查，并进行积极的早期预防和干预。
孕期宫内环境不良
目前有许多证据表明孕期宫内环境不良致胎儿宫内发育迟缓(IUGR)及低出生体重(LBW)在成年后糖耐量异常、胰岛素抵抗、血脂紊乱及动脉粥样硬化的发病率偏高。Frontini等[8]对不同种族儿童的多年随访调查表明，那些低出生体重儿长至4～11岁时，较出生体重正常的同年龄段儿童LDL和血糖水平明显增高，而HDL水平明显降低；发育至青少年后期收缩压、LDL及血糖水平较对照组明显升高。他们的研究还得出结论：无论何种族、性别的儿童，SBP、TG及血糖浓度均与低出生体重呈独立负相关趋势。Hattersley等[9]发现出生体重低及胰岛素分泌异常与胎儿基因型的缺陷有关。Radunovic等[10]研究发现母孕期宫内环境不良致宫内发育迟缓的胎儿apoB水平偏高，这可能是其成年后冠心病发病率高的原因之一。
, http://www.100md.com
参考文献
1Saito I,Nishino M,Kawabe H,et al.Leisure time physical activity and insulin resistance in obese students with hypertension.Am J Hypertens,1992,5:915-918.
2Taimela S,Lehtiamaki T,Porkka KV,et al.The effect of physical activity on serum total and low density lipoprotein cholesterol concentrations varied with apolipoprotein E phenotype in male children and young adults.Metabolism, 1996,45:797-803.
, 百拇医药
3Reinehr T,Andler W,Denzer C,et al.Cardiovascular risk factors in overweight German children and adolescents:relation to gender,age and degree of overweight.Nutr Metab Cardiovasc Dis,2005,15:181-187.
4Ogden CL,Carroll MD,Flegal KM.Epidemiologic trends in overweight and obesity. Endocrinol Metab Clin North Am,2003, 32:741-760.
5Steinberger J,Daniels SR,et al.Obesity, insulin resistance,diabetes,and cardiovascular risk in children. Circulation, 2003,107:1448-1453.
, 百拇医药
6胡姣荣,柯春芬,仲惟昆,等.冠心病家族史少年儿童血清脂蛋白(a)的研究.解放军医学杂志, 1994,12:187-191.
7向伟,赵水平,陈炽,等.冠心病家族史儿童血浆脂类水平的研究.心血管康复医学杂志,2001, 10:300-303.
8Frontini MG,Srinivasan SR,Xu J,et al.Low birth weight and longitudinal trends of cardiovascular risk factor variables from childhood to adolescence:the bogalusa heart study.BMC Pediatr,2004,4: 22.
9Hattersley AT,Beards F,Ballantyne E,et al.Mutation in the glucokinase gene of the fetus result in reduced birth.Nat Genet,1998,19:268-270.
10 Radunovic N,Kuczynski E,Rosen T,et al.Plasma apolipoprotein A-I and B concentrations in growth-retarded fetuses: a link between low birth weight and adult atherosclerosis.J Clin Endocrinol Metab, 2000,85:85-88.
[ 上 页 ], 百拇医药(刘 颖等)
孕期宫内环境不良
目前有许多证据表明孕期宫内环境不良致胎儿宫内发育迟缓(IUGR)及低出生体重(LBW)在成年后糖耐量异常、胰岛素抵抗、血脂紊乱及动脉粥样硬化的发病率偏高。Frontini等[8]对不同种族儿童的多年随访调查表明，那些低出生体重儿长至4～11岁时，较出生体重正常的同年龄段儿童LDL和血糖水平明显增高，而HDL水平明显降低；发育至青少年后期收缩压、LDL及血糖水平较对照组明显升高。他们的研究还得出结论：无论何种族、性别的儿童，SBP、TG及血糖浓度均与低出生体重呈独立负相关趋势。Hattersley等[9]发现出生体重低及胰岛素分泌异常与胎儿基因型的缺陷有关。Radunovic等[10]研究发现母孕期宫内环境不良致宫内发育迟缓的胎儿apoB水平偏高，这可能是其成年后冠心病发病率高的原因之一。
, http://www.100md.com
参考文献
1Saito I,Nishino M,Kawabe H,et al.Leisure time physical activity and insulin resistance in obese students with hypertension.Am J Hypertens,1992,5:915-918.
2Taimela S,Lehtiamaki T,Porkka KV,et al.The effect of physical activity on serum total and low density lipoprotein cholesterol concentrations varied with apolipoprotein E phenotype in male children and young adults.Metabolism, 1996,45:797-803.
, 百拇医药
3Reinehr T,Andler W,Denzer C,et al.Cardiovascular risk factors in overweight German children and adolescents:relation to gender,age and degree of overweight.Nutr Metab Cardiovasc Dis,2005,15:181-187.
4Ogden CL,Carroll MD,Flegal KM.Epidemiologic trends in overweight and obesity. Endocrinol Metab Clin North Am,2003, 32:741-760.
5Steinberger J,Daniels SR,et al.Obesity, insulin resistance,diabetes,and cardiovascular risk in children. Circulation, 2003,107:1448-1453.
, 百拇医药
6胡姣荣,柯春芬,仲惟昆,等.冠心病家族史少年儿童血清脂蛋白(a)的研究.解放军医学杂志, 1994,12:187-191.
7向伟,赵水平,陈炽,等.冠心病家族史儿童血浆脂类水平的研究.心血管康复医学杂志,2001, 10:300-303.
8Frontini MG,Srinivasan SR,Xu J,et al.Low birth weight and longitudinal trends of cardiovascular risk factor variables from childhood to adolescence:the bogalusa heart study.BMC Pediatr,2004,4: 22.
9Hattersley AT,Beards F,Ballantyne E,et al.Mutation in the glucokinase gene of the fetus result in reduced birth.Nat Genet,1998,19:268-270.
10 Radunovic N,Kuczynski E,Rosen T,et al.Plasma apolipoprotein A-I and B concentrations in growth-retarded fetuses: a link between low birth weight and adult atherosclerosis.J Clin Endocrinol Metab, 2000,85:85-88.
[ 上 页 ], 百拇医药(刘 颖等)