不同胎龄早产儿暂时性低甲状腺素血症发生情况比较及小剂量甲状腺素治疗效果分析  

Comparison of the incidence of transient hypothyroxinemia in preterm infants of different gestational age and analysis of the effect of low-dose thyroxine treatment

作　　者：潘程秀 李慧慧 PAN Cheng-xiu;LI Hui-hui(Department of Neonatology,Wenzhou City Hospital,Wenzhou,Zhejiang325000,China;不详)

机构地区：[1]温州市中心医院新生儿科,浙江温州325000 [2]杭州师范大学附属医院新生儿科

出　　处：《中国妇幼保健》2023年第8期1403-1406,共4页Maternal and Child Health Care of China

基　　金：浙江省自然科学基金(LGF18H150138)。

摘　　要：目的探讨不同胎龄早产儿暂时性低甲状腺素血症(THP)发生情况比较及小剂量甲状腺素治疗效果。方法选取2015年1月—2019年12月间收治的244例早产儿作为研究对象,根据胎龄将患儿分为A组(胎龄28~31周,87例)、B组(胎龄32~34周,80例)、C组(胎龄35~36周,77例)。评估各组早产儿甲状腺功能,比较各组早产儿THP发生率。THP患儿以胎龄、性别、体质量作为配对因素进行配对,对照组行常规早产儿治疗,观察组在此基础上增加小剂量甲状腺素治疗。比较两组临床症状变化情况,治疗前、治疗2周后,评估两组患儿甲状腺功能,于纠正胎龄40+2周时评估患儿神经功能,记录药物不良反应。结果A组TSH、T4和T3水平分别为(5.38±1.08)mU/L、(108.48±19.15)nmol/L、(1.12±0.28)nmol/L;B组TSH、T4和T3水平分别为(4.87±1.24)mU/L、(116.41±18.10)nmol/L、(1.45±0.35)nmol/L;C组TSH、T4和T3水平分别为(4.53±1.13)mU/L、(137.53±14.84)nmol/L、(1.59±0.30)nmol/L。A组、B组和C组TSH、T4和T3比较,差异均有统计学意义(F=11.210、60.107、48.805,均P<0.05);B组和C组TSH均低于A组(t=2.840,P=0.005;t=4.922,P=0.000),B组和C组T4、T3均高于A组(t=2.744,P=0.007;t=6.753,P=0.000;t=10.755,P=0.000;t=10.374,P=0.000),C组T4、T3均高于B组(t=7.978,P=0.000;t=10.152,P=0.000)。A组、B组及C组患儿THP发生率分别为37.93%、22.50%、14.29%,不同胎龄患儿THP发生率比较,差异有统计学意义(χ^(2)=12.581,P=0.002),C组THP发生率低于A组(P<0.05);观察组达全胃喂养时间、喂养不耐受持续时间及住院时间分别为(14.84±2.11)d、(10.81±2.94)d、(23.83±4.73)d,均短于对照组的(16.04±2.42)d、(13.32±3.99)d、(27.37±5.40)d,差异均有统计学意义(t=2.081,P=0.042;t=2.820,P=0.007;t=2.746,P=0.008);治疗两周后,两组T4、T3水平均高于治疗前,差异均有统计学意义(均P<0.05),观察组治疗后T4、T3高于同期对照组(P<0.05);观察组NABA总分、行为能力均分、肌张力均分分别为(37.55±1.98)�Objective To investigate the incidence of transient hypothyroxinemia(THP)in premature infants of different gestational age and the therapeutic effect of low-dose thyroxine.Methods A total of 244 preterm infants admitted from January 2015 to December 2019 were enrolled in this study.According to the gestational age,the infants were divided into three groups:group A(gestational age 28-31 weeks,87 cases),group B(gestational age 32-34 weeks,80 cases)and group C(gestational age 35-36 weeks,77 cases).Thyroid function was assessed and the incidence of THP was compared.The children with THP were matched according to gestational age,sex and body weight.The control group received routine treatment for premature infants,while the observation group received low-dose thyroxine treatment on the basis of routine treatment.The changes of clinical symptoms were compared between the two groups.The thyroid function was evaluated before treatment and 2 weeks after treatment.The neurological function was evaluated at corrected gestational age of 40^(+2)weeks,and adverse drug reactions were recorded.Results The levels of TSH,T4 and T,in group A were(5.38+1.08)mU/L,(108.48±19.15)nmol/L and(1.12±0.28)nmol/L,respectively.The levels of TSH,T4 and T,in group B were(4.87±1.24)mU/L,(116.41±18.10)nmol/L and(1.45±0.35)nmol/L respectively.The levels of TSH,T4 and T,in group C were(4.53±1.13)mU/L,(137.53±14.84)nmol/L and(1.59±0.30)nmol/L,respectively.There were significant differences in TSH,T4 and T,among group A,group B and group C(F=11.210,60.107,48.805,all P<0.05).TSH in group B and C were lower than that in group A(t=2.840,P=0.005;t=4.922,P=0.000);T4 and T,in group B and C were higher than those in group A(t=2.744,P=0.007;t=6.753,P=0.000;t=10.755,P=0.000;t=10.374,P=0.000);T4 and T,in group C were higher than those in group B(t=7.978,P=0.000;t=10.152,P=0.000).The incidence of THP was 37.93%in group A,22.50%in group B and 14.29%in group C,respectively.There was significant difference in the incidence of THP among different gestational

关 键 词：早产儿 暂时性低甲状腺素血症 胎龄 小剂量甲状腺素 神经行为 

分 类 号：R722.12[医药卫生—儿科]