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저체중아의 출생 시 제대혈에서 adiponectin, IGF-I, IGFBP-1, insulin 및 leptin에 관한 연구

Study of umbilical cord blood adiponectin, IGF-I, IGFBP-1, insulin and leptin levels in small for gestational age neonates at birth

박미혜|김영주|안정자|전선희|최노미
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2009.04|Obstetrics & Gynecology Science|제52권 제4호|pp. 420-428

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키워드

저체중아AdiponectinLeptinInsulinIGF-ISmall for gestational ageIGFBP-1
주제분류산부인과학

초록

목적: 제대혈액 내 adiponectin, IGF-I, IGFBP-1, insulin, leptin이 태아성장에 관여할 가능성을 알아보고자 35주 이상의 신생아 분만 시 제대혈에서 호르몬들의 농도를 측정하여, 저체중아와 정상체중아 사이에 당대사에 관련된 호르몬들의 농도의 차이가 있는지를 알아보고, 각 호르몬간의 상관관계 유무와, 출생체중과 ponderal index에 영향을 미치는 요인을 알아보기 위하여 다중회귀분석을 실시하여 분석하였다. 연구 방법: 2007년 1월부터 12월까지 이화여자대학교 목동병원 산부인과에서 35주 이후에 분만한 산모 중에서 저체중아를 분만한 산모 30명과 정상 체중아를 분만한 산모 30명을 대상으로 하였다. 저체중아군과 대조군인 정상체중아의 분만 시 제대정맥혈액을 채취하여 원심분리 후 분리된 혈청을 방사선면역측정법과 효소면역측정법 등의 방법으로 측정하여 비교분석하였다. 결과: 1. 임상적인 특성을 비교한 결과, 신생아의 출생 시 체중, 키, 머리둘레, 배둘레, 가슴둘레, ponderal index (PI)는 정상체중아에 비하여 저체중아에서 모두 의미있게 작았다. 2. 정상체중아에 비하여 저체중아에서 제대혈액 내 adiponectin, IGF-I, IGF/IGFBP ratio는 의미있게 작았으나, IGFBP-1은 저체중아에서 의미있게 높았다. 그러나 insulin은 정상체중아에 비하여 저체중아에서 증가 경향을 보였으나 P=0.053으로 유의하지는 않았고, leptin은 두 군 간에 차이를 보이지 않았다. 3. 제대혈액 내 각 호르몬간의 상호관계를 전체 신생아를 대상으로 분석한 결과 adiponectin과 IGFBP-1과는 음의 상관관계, IGF-I과는 양의 상관관계, IGF/IGFBP ratio와는 양의 상관관계가 있었으며, IG F-I과 IGFBP-1은 음의 상관관계, insulin과 leptin은 양의 상관관계를 보였다. 4. 신생아 출생체중과 PI에 대한 제대혈액 내 호르몬들의 다중회귀분석 결과, 출생체중에는 adiponectin과 IGF-I이, PI에는 IGFBP-1만이 각각 영향있는 인자로 나왔다. 결론: 이상과 같은 연구결과로, 자궁내 태아성장에 있어 여러 인자들 중에서도 adiponectin, IGF-1 및 IGFBP-1이 에너지 균형 및 대사조절에 중요한 역할을 담당하고, 저체중아에서 adiponectin과 IGF-I의 측정은 그 신생아의 예후를 예측하는데 이용할 수 있을 것으로 사료되며, IGFBP-1은 비대칭적 자궁 내 발육부전 진단에 도움이 될 것으로 본다.

Abstract

Objective: Intrauterine growth is influenced by multiple factors like genetic, nutritional, environmental and hormonal factors. As birth weight is reported to be related to perinatal morbidity and mortality, we aimed to compare umbilical cord blood adiponectin, IGF-I, IGFBP-1, insulin and leptin levels between small for gestational age (SGA) and appropriate for gestational age (AGA) neonates at birth to investigate the influence of these factors on birth weight and ponderal index. Methods: We investigated retrospectively 30 pregnant women with SGA and 30 pregnant women with AGA who delivered at Ewha Womans University Hospital and their babies from January 2007 to December 2007. Fetal umbilical cord venous blood adiponectin, IGF-I, IGFBP-1, insulin and leptin levels from SGA and AGA neonates were obtained at the time of delivery. The definition used to identify cases of SGA was individual birth weight ratio of less than 10th percentile and the definition of ponderal index (PI) was [BW (g)/ (height (cm))3]×100. Results: Umbilical cord blood adiponectin, IGF-I and IGF/IGFBP ratio were significantly lower (P<0.05) in SGA than AGA. And umbilical cord blood IGFBP-1 were significantly higher (P<0.05) in SGA than AGA. But there was no significant difference in umbilical cord blood insulin and leptin levels between SGA and AGA neonates. Positive correlation was noted between adiponectin and IGF-I, IGF/IGFBP ratio, insulin and leptin. Negative correlation was noted between adiponectin and IGFBP-1, IGF-I and IGFBP-1. On multiple regression analysis, adiponectin and IGF-I were significant factors associated with body weight (BW), but only IGFBP-1 ws significant factor associated with PI. Conclusion: These results suggest that fetal adiponectin, IGF-I, IGFBP-1 may have an important role in regulation of intrauterine growth and we will expect that evaluation of adiponectin and IGF-I in SGA may be helpful in prediction of neonatal outcome, and IGFBP-1 may be useful in diagnosis of asymmetric intrauterine growth retardation (IUGR).

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