28~36周早产儿生后3~21天血FT3、FT4、TSH变化分析  

Changes in FT3,FT4 and TSH Levels in 3~21-day-old Preterm Infants Born at 28~36 Weeks of Gestation

作　　者：唐本玉[1] 郭蕾[1] 陈丹纯 代群[1] 李茵雅 林娟 朱顺叶[1] TANG Ben-yu;GUO Lei;CHEN Dan-chun;DAI Qun;LI Yin-ya;LIN Juan;ZHU Shun-ye(Department of Pediatrics,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Pediatrics,Guangzhou Women and Children’s Medical Center,Guangzhou 510620,China)

机构地区：[1]中山大学附属第三医院儿科,广东广州510630 [2]广州市妇女儿童医疗中心儿科,广东广州510620

出　　处：《中山大学学报（医学科学版）》2021年第4期581-588,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2014A020212392)。

摘　　要：【目的】分析28~36周早产儿生后3~21 d FT3、FT4、TSH变化的特征。【方法】回顾性分析2018年7月至2019年6月中山大学附属第三医院新生儿科住院的236例28~36周早产儿的临床资料,包括甲状腺功能检查(FT3、FT4和TSH)、胎龄、性别、出生体质量、出生身长、检查日龄、辅助生殖方式、单胎或多胎、母亲甲状腺疾病和母亲妊娠期糖尿病,比较早产儿3~7 d与8~21 d FT3、FT4和TSH水平的差异;分析影响早产儿FT3、FT4和TSH水平的独立因素;比较不同胎龄早产儿FT3、FT4和TSH水平差异。【结果】早产儿3~7 d FT3水平(3.23±0.54)pmol/L,低于8~21 d的(3.41±0.76)pmol/L,差异有统计学意义(P=0.040);早产儿3~7 d的FT4水平(15.36±3.40)pmol/L,高于8~21 d的(13.20±2.63)pmol/L,差异有统计学意义(P<0.001);3~7 d与8~21 d的TSH分布的差异没有统计学意义(P=0.846);早产儿3~7 d FT3水平受到胎龄的影响(P<0.001),3~7天FT4水平受到胎龄和检查日龄的影响(P<0.001),8~21 d的FT3、FT4水平均受到胎龄和性别的影响(P<0.001、P<0.001);3~7 d、8~21 d的FT3、FT4水平与胎龄为正相关(P<0.001,P<0.001;P<0.001,P=0.001)。【结论】胎龄影响生后3~21 d早产儿的甲状腺功能,胎龄越小,FT3、FT4越低,需要建立一个胎龄相关的的FT4或T4参考范围,结合TSH联合评估甲状腺功能。【Objective】To analyze the changes of serum levels of free triiodothyronine(FT3),free thyroxin(FT4)and thyroid-stimulating hormone(TSH)in 3~21-day-old preterm infants born between 28 and 36 weeks of gestation.【Methods】We retrospectively reviewed the clinical data of 236 preterm infants born at 28~36 weeks of gestation in the third affiliated hospital of Sun Yat-sen university between July 2018 and June 2019.The clinical data included thyroid function parameters(FT3,FT4,TSH),gestational age,gender,birth weight,birth length,time of examination,mode of conception,singleton or multiple birth,maternal thyroid disease and maternal gestational diabetes mellitus(GDM).FT3,FT4 and TSH levels between 3~7-day-old and 8~21-day-old preterm infants were compared.Multiple linear regression models were used to identify the independent factors affecting FT3,FT4 and TSH levels.FT3 and FT4 levels in different gestational age groups were compared.【Results】Compared with those in 8~21-day-old preterm infants,in 3~7-day-old preterm infants,FT3 levels were significantly lower[(3.23±0.54)pmol/L vs.(3.41±0.76)pmol/L,P=0.040]and FT4 levels were significantly higher[(15.36±3.40)pmol/L vs.(13.20±2.63)pmol/L,P<0.001)].No statistical difference was found in TSH levels.(P=0.846).In 3~7-day-old preterm infants,FT3 levels were associated with gestational age(P<0.001);FT4 levels were associated with gestational age and time of examination(P<0.001).In 8~21-day-old preterm infants,both FT3 and FT4 levels were associated with gestational age and gender(P<0.001,P<0.001).FT3 and FT4 were positively correlated with gestational age in both groups(P<0.001,P<0.001;P<0.001,P=0.001)【Conclusion】Gestational age affects the thyroid function of the preterm infants of 3~21 days.The younger the gestational age,the lower FT3 and FT4 levels.A reference range of FT4 or T4 related to gestational age should be established,combined with TSH,to evaluate the thyroid function in preterm infants.

关 键 词：早产儿 三碘甲状腺原氨酸 四碘甲状腺原氨酸 促甲状腺素 

分 类 号：R72[医药卫生—儿科]