季节变化对河南省新生儿先天性甲状腺功能减低症筛查结果和TSH切值影响的情况分析  

Analysis of influence of seasonal variation on the screening results of congenital hypothyroidism and TSH cut-off value of newborns in Henan province

作　　者：张秋月 刘素娜[2] 吕书博[2] 欧阳运佳 张洁[2] 赵德华[2] ZHANG Qiu-yue;LIU Su-na;LV Shu-bo;OUYANG Yun-jia;ZHANG Jie;ZHAO De-hua(Clinical Laboratory,Women and Infants Hospital of Zhengzhou,Zhengzhou 450012,China;Neonatal disease Screening Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州市妇幼保健院检验科,郑州450012 [2]郑州大学第三附属医院新生儿疾病筛查科,郑州450052

出　　处：《医药论坛杂志》2023年第9期36-40,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102182)。

摘　　要：目的 了解河南省新生儿先天性甲状腺功能减低症(CH)促甲状腺素(TSH)的季节变化,探讨季节变化对新生儿CH筛查结果和切值的影响。方法 收集2016年1月至2022年12月在郑州大学第三附属医院新生儿疾病筛查中心接受筛查的6 695 024例新生儿干血斑标本,用时间分辨免疫荧光分析法检测血中TSH浓度,将结果按照季节分为4组,用百分位数法计算切值并比较初筛阳性率和发病率是否存在差异。结果 2016—2022年共筛查新生儿6 695 024例,确诊CH 4 903例,CH发病率呈逐年上升趋势。春、夏、秋、冬季节的CH初筛阳性率分别为8.25‰、3.38‰、5.78‰和12.41‰,发病率分别为7.12‱、6.06‱、6.69‱和9.40‱,春冬季CH初筛阳性率和确诊率均高于夏秋季,差异具有统计学意义(P<0.05);不同季度出生的新生儿TSH值P99差异有统计学意义(P<0.05)。结论 河南省新生儿CH发病率为1/1 377(7.26∶10000),高于中国北方其它地区。不同季节新生儿CH初筛阳性率和发病率有显著性差异,温度较低的季节例如冬季初筛阳性率和发病率较高,而夏季温度较高,初筛阳性率和发病率最低,建议不同季节根据当地情况和实验室统计数据设定不同的切值,以减少初筛阳性率,也为河南地区新生儿CH的筛查和治疗提供了新的依据。Objective To investigate the seasonal variation of thyroid stimulating hormone(TSH)in neonatal screening for congenital hypothyroidism(CH)in Henan Province,and to explore the influence of seasonal variation on the screening results and cut-off values of CH.Methods Dry blood spot samples were collected from 6695024 neonates screened in the Screening Center of Neonatal Disease in the Third Affiliated Hospital of Zhengzhou University from January 2016 to De⁃cember 2022.TSH concentration in blood was detected by time-resolved immunofluorescence assay,and the results were divided into 4 groups according to the season.The percentile method was used to calculate the cut-off value and compare the difference between the positive rate of initial screening and the incidence rate of CH.Results A total of 6695024 neonates were screened from 2016 to 2022,and 4903 cases of CH were confirmed,with the incidence of CH increasing year by year.The primary screening positive rate of CH in spring,summer,autumn and winter were 8.25‰,3.38‰,5.78‰and 12.41‰,respectively.The primary screening positive rate in spring and winter were higher than those of sum⁃mer and autumn,and the difference was statistically significant(P<0.05);The incidence rate of CH in spring,summer,autumn and winter were 7.12‱、6.06‱、6.69‱and 9.40‱,respectively,among which incidence rate of CH were signif⁃icantly higher in spring and winter those of summer and autumn(P<0.05).The P99 values of newborns born in different quar⁃ters were significantly different(P<0.05).Conclusion Incidence rate of CH in Henan is 1/1377(7.26∶10000),high⁃er than that of the other areas in northern China.There are significant differences in primary screening positive rate and in⁃cidence rate in different seasons.The primary screening positive rate and incidence rate of neonatal CH initial screening are higher in winter when the temperature is low,while the primary screening positive rate and incidence rate of neonatal CH initial screening are lowest when the te

关 键 词：先天性甲状腺功能减低症 季节变化 新生儿筛查 河南省 切值 

分 类 号：R722.1[医药卫生—儿科]