早产儿先天性甲状腺功能减退症发病及临床转归因素分析  

Congenital hypothyroidism in preterm infants:analysis of factors in the pathogenesis and clinical prognosis

作　　者：赵金琦[1] 杨海河[1] 杨楠[1] 宫丽霏[1] 唐玥 李璐璐 孔元原[1] Zhao Jinqi;Yang Haihe;Yang Nan;Gong Lifei;Tang Yue;Li Lulu;Kong Yuanyuan(Department of Newborn Screening,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院新生儿疾病筛查科,北京100026

出　　处：《中华新生儿科杂志（中英文）》2023年第2期70-73,共4页Chinese Journal of Neonatology

摘　　要：目的探讨早产儿先天性甲状腺功能减退症(congenital hypothyroidism,CH)的特点及暂时性CH(transient congenital hypothyroidism,TCH)和永久性CH(permanent congenital hypothyroidism,PCH)的预测因素。方法选择2008年1月至2018年6月在北京市出生并经北京市新生儿疾病筛查中心筛查、确诊并治疗的早产CH患儿进行回顾性研究,按临床转归分为TCH组和PCH组,采用单因素和多因素Logistic回归模型分析早产CH患儿转归为PCH的预测因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线确定最佳切点。结果研究期间共筛查新生儿2216892名,初筛阳性15382例,筛查时间为生后4(4,10)d,复查时间为生后30(22,42)d,复查14576例,复查率94.8%;确诊早产CH患儿92例,其中60例诊断为TCH,占65.2%;28例诊断为PCH,占30.4%;4例失访,占4.3%。单因素分析显示,PCH组甲状腺B超异常率(包括位置、大小和回声结构异常)、1岁时左旋甲状腺素(levothyroxine,LT4)药量、2岁时促甲状腺素(thyroid-stimulating hormone,TSH)水平、2岁时LT4药量、3岁时LT4药量和3岁时游离甲状腺素水平均高于TCH组(P<0.05);Logistic回归分析显示,B超异常(OR=12.184,95%CI 2.270~65.403),2岁时TSH水平高(OR=2.033,95%CI 1.280~3.228)和3岁时药量大(OR=21.435,95%CI 3.439~133.584)是发生PCH的危险因素。3岁时药量的ROC曲线下面积最大,为0.798(95%CI 0.680~0.916),最佳切点为1.3μg/(kg·d);其次为2岁时TSH水平,为0.683(95%CI 0.548~0.817),最佳切点为4.51μIU/ml。结论早产CH中TCH占比多;随访中3岁时药量大和2岁时TSH水平高是PCH的早期预测因素。Objective To investigate the characteristics of congenital hypothyroidism(CH)in premature infants and analyze the predictors of transient congenital hypothyroidism(TCH)and permanent CH(PCH).Methods A retrospective study was conducted on the preterm infants with CH born in Beijing from January 2008 to June 2018.They were screened,diagnosed and treated by the Beijing Neonatal Disease Screening Center.They were assigned into TCH and PCH groups according to the clinical prognosis.Univariate analysis and Logistic regression analyses were used to determine the predictors of PCH,and the receiver operating characteristic curve(ROC)was drawn to determine the best cut-off point.Results A total of 2216892 newborns were screened,15382 were initially screened positive,the median time of screening was 4(4,10)d after birth,and the median time of postnatal reexamination was 30(22,42)d after birth,14576 newborns were reexamined,the reexamination rate was 94.8%.A total of 92 preterm infants were diagnosed with CH,of which 60 were TCH,accounting for 65.2%;28 were PCH,accounting for 30.4%;and 4 were lost to follow-up,accounting for 4.3%.Univariate analysis showed that in the PCH group,the abnormal rate of thyroid B-ultrasound,levothyroxine(LT4)dose at 1-year old,thyrotropin(TSH)level at 2 years old,LT4 dose at 2 years old,LT4 dose and free thyroxine(FT4)level at 3 years old were higher than those in the TCH group.Logistic regression analysis revealed that abnormal B-ultrasound(OR=12.184,95%CI 2.270~65.403),and elevated TSH level at 2 years old(OR=2.033,95%CI 1.280~3.228),increased LT4 dose at 3 year old(OR=21.435,95%CI 3.439~133.584)are the risk factors for PCH.The maximum area under ROC curve was 0.798 at 3 years old(95%CI 0.680~0.916),the best cut-off point was 1.3μg/(kg·d)for the 3-year-old drug dose;followed by 2-year-old TSH level,which was 0.683(95%CI 0.548~0.817),the best cut-off point was 4.51μIU/ml.Conclusions TCH accounted for a large proportion of preterm infants with CH.During the follow-up,the increased LT4 dose at 3

关 键 词：先天性甲状腺功能减退症 早产儿 治疗 转归 B超 

分 类 号：R722.6[医药卫生—儿科]