晚期早产儿甲状腺功能的动态变化及甲状腺功能减退症和延迟性促甲状腺激素升高的影响因素  

Dynamic variations of thyroid function and risk factors for hypothyroidism and delayed thyroid stimulating hormone elevation in late preterm infants

作　　者：田强 崔曙东[1] Tian Qiang;Cui Shudong(Department of Pediatrics,Nanjing Medical University First Affiliated Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院儿科,210029

出　　处：《中华围产医学杂志》2021年第5期360-365,共6页Chinese Journal of Perinatal Medicine

基　　金：江苏省妇幼健康重点学科(FXK201730)。

摘　　要：目的探讨晚期早产儿甲状腺功能的动态变化,以及甲状腺功能减退症(简称甲减)和延迟性促甲状腺激素(thyroid stimulating hormone,TSH)升高的影响因素。方法回顾性纳入2017年1月至2019年12月在南京医科大学第一附属医院住院并进行甲状腺功能监测的晚期早产儿782例。新生儿生后4~7 d进行第1次甲状腺功能检测,生后2~4周或第1次检测异常2周后进行第2次甲状腺功能检测,仍有异常者,定期复查,直至甲状腺功能正常或诊断甲减并开始治疗。分析不同类型甲状腺功能异常患儿的甲状腺激素变化特点。将患儿分为甲减组(11例)和非甲减组(771例),比较组间围产期特点的差异,并探讨甲减的危险因素;再将患儿分为延迟性TSH升高组(71例)与甲状腺功能始终正常组(450例),比较组间围产期特点的差异,探讨延迟性TSH升高的危险因素。采用两独立样本t检验、χ2检验进行组间比较,危险因素分析采用多因素logistic回归分析。结果(1)甲状腺功能变化特点:782例晚期早产儿中,5例患儿第1次检测诊断低甲状腺素血症,第2次检测恢复正常。249例患儿(31.8%)出现高TSH血症,其中4例在后续检测中诊断甲减。71例患儿(9.1%)出现延迟性TSH升高,但后续检测均恢复正常。11例患儿(1.4%)诊断甲减并给予甲状腺素替代治疗,其中7例于第1次检测时诊断,3例于第2次检测时诊断,而1例患儿于第3次检测才诊断。(2)甲减的危险因素:与非甲减组相比,甲减组患儿出生体重更低[(2140.9±455.1)与(2464.1±474.0)g,t=-2.247,P=0.025],多因素logistic回归分析显示,出生体重每降低1 g,甲减风险升高0.002倍(OR=1.002,95%CI:1.000~1.004,P=0.045)。(3)延迟性TSH升高的危险因素:与甲状腺功能始终正常组相比,延迟性TSH升高组患儿出生体重更低[(2395.4±420.9)与(2523.6±462.3)g,t=-2.200,P=0.028],而小于胎龄儿和双胎儿比例更高[15.5%(11/71)与7.1%(32/450),χ^(2)=5.690,P=0.017;29.6%(21/71)Objective To investigate the dynamic changes of thyroid function and risk factors of hypothyroidism and delayed thyroid stimulating hormone(TSH)elevation in late preterm infants.Methods This study retrospectively recruited 782 late preterm infants admitted to Nanjing Medical University First Affiliated Hospital and performed thyroid function monitoring from January 2017 and December 2019.Thyroid function test was performed in all cases at 4-7 d after birth and repeated at 2-4 weeks of age for those with normal results or two weeks after the first test for those with abnormal.The test would be continued if the second test was abnormal and stopped until the thyroid function became normal or hypothyroidism was diagnosed,based on which,these infants were divided into hypothyroidism(n=11)and non-hypothyroidism groups(n=771),or delayed TSH elevation(n=71)and normal thyroid function groups(n=450).The characteristics of thyroid hormone changes and perinatal data were compared between different groups using two independent sample t-test and Chi-square test,and risk factors of hypothyroidism and delayed TSH elevation were analyzed using logistic regression tests.Results(1)Dynamic changes of thyroid function:among these 782 late preterm infants,five infants were found with transient hypothyroxinemia at the first test,and became normal at the second test;249(31.8%)exhibited hyperthyrotropinemia,and four of them were diagnosed with hypothyroidism based on the second and the third results;71(9.1%)with delayed TSH elevation all became normal later;11(1.4%)were diagnosed with hypothyroidism and treated with thyroxine,among which,seven cases were diagnosed at the first test,three at the second test and one at the third test.(2)Risk factors for hypothyroidism:lower birth weight was noted for infants with hypothyroidism compared with those without[(2140.9±455.1)vs(2464.1±474.0)g,t=-2.247,P=0.025].Multivariate logistic regression analysis found that for every one gram reduction in birth weight,the risk of hypothyroidism elevated b

关 键 词：婴儿 早产 疾病 甲状腺功能减退症 促甲状腺素 

分 类 号：R722.6[医药卫生—儿科]