先天性甲状腺功能低下症的发病与转归的围产因素分析  

Analysis of perinatal factors of occurrence and evolution of congenital hypothyroidism

作　　者：马文娜 MA Wenna(Department of Child Health,Linyi Municipal Women and Childrens Hospital,Shandong Linyi 276000,China)

机构地区：[1]临沂市妇女儿童医院儿童保健科,山东临沂276000

出　　处：《中国妇幼健康研究》2020年第4期470-474,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的评估临沂市地区与先天性甲状腺功能低下症(CH)发病相关的围产因素,以及评估与暂时性CH(TCH)和永久性CH(PCH)转归相关的危险因素。方法于2014年1月至2018年6月,收集在临沂市妇女儿童医院筛查阳性并治疗的130例CH患儿作为病例组,并在同一时间段内随机选取130例甲状腺功能正常的新生儿作为对照组,通过单因素分析和多因素Logistic回归模型比较分析两组新生儿及其母亲的临床变量,评估CH发病相关的危险因素;对进行常规药物治疗的CH患儿作定期随访至3岁左右,利用甲状腺功能检测及影像学检查对CH患儿做出TCH和PCH的诊断,通过单因素分析和多因素Logistic回归模型比较分析TCH和PCH两组的临床变量,评估PCH转归的危险因素。结果单因素分析显示病例组中女性、早产儿、低出生体重儿、多胎和伴有其他出生缺陷,以及高龄产妇、伴有妊娠期糖尿病、高血压者和妊娠期合并甲状腺疾病的比例高于对照组(χ^2分别为4.49,5.78,7.98,5.59,8.56,4.00,5.73,5.76,5.64,P均<0.05)。多因素Logistic回归分析显示早产儿(OR=2.96,95%CI:1.26~4.62)、低出生体重儿(OR=2.61,95%CI:1.60~3.24)、伴有其他出生缺陷(OR=3.66,95%CI:2.21~5.74),以及妊娠期高血压(OR=2.21,95%CI:1.14~3.55)、糖尿病(OR=3.48,95%CI:1.36~4.85)、妊娠期合并甲状腺疾病(OR=4.75,95%CI:2.48~6.17)是新生儿CH发病的危险因素,差异均具有统计学意义(P均<0.05)。此外,单因素分析显示PCH在第3年的左甲状腺素用药量高于TCH组(χ^2=13.66,P<0.01)。结论新生儿及其母亲的多种变量可被认为是CH发病的危险因素,并且第3年左甲状腺素高需药量可以作为PCH转归的危险因素。Objective To investigate perinatal factors associated with congenital hypothyroidism(CH) in Linyi city,and to assess risk factors associated with outcomes of transient CH(TCH) and permanent CH(PCH).Methods Totally 130 neonates with positive CH result who were screened and treated in Linyi Municipal Woman and Children’s Hospital were selected as case group and other 130 neonates with normal thyroid function in the same period were selected randomly as control group.Univariate analysis and multifactorial logistic regression analysis were performed to compare clinical variables of the neonates and their mothers,and to evaluate the risk factors of CH.The neonates with CH who received routine drug therapy were regularly followed up to about 3 years old,and the diagnosis of TCH and PCH was determined by thyroid function test and imaging examination.The clinical variables of TCH and PCH were compared and analyzed,and the predictive factors of CH outcomes were evaluated by univariate analysis and multifactorial logistic regression analysis.Results Univariate analysis indicated that proportions of female gender,premature birth,low birth weight infant,multiple birth,accompanying with other birth defects,as well as older maternal age,accompanying with gestational diabetes mellitus(GDM),pregnancy-induced hypertension(PIH),and pregnancy associated with thyroid disease in the case group were significantly higher than those in the control group(χ^2=4.49,5.78,7.98,5.59,8.56,4.00,5.73,5.76 and 5.64 respectively,all P<0.05).Multifactorial logistic regression analysis indicated that premature infant(OR=2.96,95%CI:1.26~4.62),low birth weight infant(OR=2.61,95% CI:1.60~3.24),accompanying with other birth defects(OR=3.66,95%CI:2.21~5.74),accompanying with GDM(OR=2.21,95%CI:1.14~3.55),PIH(OR=2.21,95%CI:1.14~3.55),and pregnancy associated with thyroid disease(OR=4.75,95%CI:2.48~6.17) were risk factors of neonatal CH,and the differences were statistically significant(all P<0.05).Additionally,univariate analysis indicated that levothyr

关 键 词：先天性甲状腺功能低下症 暂时性 永久性 危险因素 临床转归 

分 类 号：R725.8[医药卫生—儿科]