双胎妊娠生长不一致对新生儿甲状腺功能的影响  

Effects of growth-discordant twin pregnancies on thyroid function of neonates

作　　者：陈怡博[1] 余颀[1] 陈志央[1] 庄丹燕[1] 潘婕文[1] 王飞[1] 卢文波[1] Chen Yibo Yu Qi Chen Zhiyang Zhuang Danyan Pan Jiewen Wang Fei Lu Wenbo(Department of Clinical Laboratory, Ningbo Women and Children＇s Hospital, Ningbo Municipal Key Laboratory of Maternal-Fetal Medicine, Ningbo 315010, China)

机构地区：[1]浙江省宁波市妇女儿童医院检验科 宁波市母胎医学研究重点实验室,315010

出　　处：《中华围产医学杂志》2016年第11期850-854,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的 探讨双胎妊娠生长不一致对新生儿促甲状腺素（thyroid stimulating hormone，TSH）水平及先天性甲状腺功能减退症（congenital hypothyroidism，CH）发病的影响。方法 研究对象为2012年1月1日至2014年12月30日宁波市10个县（市、区）出生的活产多胎妊娠新生儿3 444例。按规范采集新生儿足跟血送检。比较单、双胎妊娠新生儿先天性甲状腺功能减退症的发病情况。以双胎胎儿体重差≥25%作为双胎妊娠生长不一致的诊断标准，比较先天性甲状腺功能减退症发病双胎、正常双胎体重不一致组和体重一致组TSH和17α羟孕酮水平的差异。采用χ^2检验或非参数检验进行统计学分析。结果 双胎妊娠新生儿CH发病率为0.56%（19/3 444），高于同期单胎妊娠的0.09%（203/225 712），差异有统计学意义（χ^2=76.225，P〈0.01）。19例双胎妊娠CH患儿中，8例（4对）双胎均为CH，11例为双胎妊娠一胎发病。8例双胎同时发病的患儿，出生胎龄均〈37周，男、女性各4例；5例为低出生体重儿；3对为单绒毛膜双胎，1对为双绒毛膜双胎。11例双胎妊娠一胎发病的患儿中，9例出生胎龄〈37周，8例为低出生体重儿；男性6例，女性5例；7例为单绒毛膜双胎，4例为双绒毛膜双胎。5例暂时性甲低患儿均为体重不一致者中出生体重较低者。体重不一致组中，CH患儿出生体重低于其正常同胎新生儿[M（P25~P75），分别为2 100（1 800~2 600）与2 770（2 530~2 960）g，Z=4.369]，TSH水平高于其正常同胎新生儿[15.4（11.8~18.5）与6.4（4.8~7.9） mU/L，Z=6.339]，差异均有统计学意义（P值均〈0.05）。正常双胎体重一致组和体重不一致组中，体重较轻一胎新生儿的TSH水平相对较高[体重一致组中为3.6（2.5~4.7）与2.4（1.8~2.9） mU/L，Z=0.962；体重不一致组中，为6.0（4.4~7.8）与3.4（1.9~4.1） mU/L，Z=4.369；P值均〈0.05]。结论 生长不一致的�Objective To investigate the effects of growth-discordant twin pregnancies on neonatal thyroid stimulating hormone （TSH） level and congenital hypothyroidism （CH）.Methods A total of 3 444 live-birth twin neonates born between January 1, 2012 and December 30, 2014 in Ningbo City were enrolled. Blood samples via heel puncture were collected and tested. Incidence of CH in singleton and twin neonates was compared. Deviation of birth weight larger than 25% in twin neonates was set as the criteria for discordant growth. TSH and 17α-hydroxylase levels in CH twins and normal twins, with or without discordant growth, were compared. Chi-square and non-parametric statistics were performed for data analysis.Results The incidence of CH in twin neonates was 0.56% （19/3 444）, higher than that in singleton neonates [0.09% （203/225 712）, χ^2=76.225, P〈0.01]. Among nineteen CH twins, CH occurred in both twins in eight cases （four twins） and in one of the twins in eleven cases. The gestational age at birth in the eight CH twins were less than 37 weeks, with four males and four females; five were low birth weight infants; one twin were dichorionic, and three twins were monochorionic. In the eleven cases of CH occurring in one of the twins, the gestational age was less than 37 weeks in nine cases, eight were low birth weight infants, six were male and five female; seven were monochorionic and four were dichoronic twins. Five cases of temporary hypothyroidism were all low birth weight infants among the growth-discordant twins. CH cases in growth-discordant group had lower birth weight than their normal twins [M（P25-P75）, 2 100 （1 800-2 600） vs 2 770 （2 530-2 960） g, Z=4.369], and a higher TSH level [15.4 （11.8-18.5） vs 6.4 （4.8-7.9） mU/L, Z=6.339] （both P〈0.05）. In normal twins with or without discordant growth, the neonates with a lower birth weight had a higher TSH level [3.6（2.5-4.7） vs 2.4（1.8-2.9） mU/L, Z=0.962] in weight consistent group, compared with 6.0（4.4-7.8） vs

关 键 词：先天性甲状腺功能减退症 促甲状腺素 双生 婴儿 出生时低体重 

分 类 号：R722.1[医药卫生—儿科]