双胎早产儿之一合并暂时性低甲状腺素血症的影响因素分析  

Factors influencing transient hypothyroxinemia in one premature twin

作　　者：林蓓蓓[1] 缪克凡[2] 林威[1] Lin Beibei;Miao Kefan;Lin Wei(Department of Pediatric Intensive Care Unit,Yuying Children's Hospital,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Pediatrics,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童重症医学科,温州325000 [2]温州医科大学附属第一医院儿科,温州325000

出　　处：《中华围产医学杂志》2023年第10期852-857,共6页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金(82201902);浙江省医药卫生科技项目(2023RC048);温州市科技计划项目(Y20180258,Y20210305)。

摘　　要：目的研究双胎早产儿之一合并暂时性低甲状腺素血症(transient hypothyroxinemia,TH)的影响因素。方法回顾性选取2009年6月至2021年9月在温州医科大学附属第二医院新生儿科收治的出生胎龄26~36周的283对双胎早产儿,在生后11~20 d检测甲状腺素(thyroxine,T4)、三碘甲状腺原氨酸(triiodothyronine,T3)和促甲状腺激素(thyroid stimulating hormone,TSH),其中47对双胎早产儿之一符合TH诊断的早产儿作为TH组,双胎另一早产儿排除TH诊断作为对照组,2组分别为47例。采用Pearson相关性分析T4与出生胎龄和出生体重的相关性,采用配对t检验、Wilcoxon符号秩和检验或McNemar检验,以及条件logistic回归分析双胎早产儿之一TH的影响因素。结果47对双胎早产儿,共94例,出生胎龄为(31.4±2.3)周(26~36周),出生体重为(1611.9±389.3)g(800~2510 g);异卵双胎35对,同卵双胎11对,1对同异卵情况不详。早产儿血清T4水平与出生胎龄、出生体重均呈正相关(相关系数分别为0.209和0.376,P值均<0.05)。单因素分析结果显示,TH组与对照组比较P<0.1的因素包括:女性[29.8%(14/47)与14.9%(7/47),χ2=3.27]、合并支气管肺发育不良[31.9%(15/47)与19.1%(9/47),χ2=3.13]、出生体重[(1547.9±348.0)与(1676.0±420.5)g,t=-3.61]、白细胞计数[(10.0±3.3)×10^(9)/L与(10.9±3.3)×10^(9)/L,t=-2.19]、维生素D[(42.8±12.1)与(45.9±16.6)nmol/L,t=-1.76]。维生素D水平数据不完整,剔除该因素后logistic回归分析显示,女性为危险因素(OR=18.388,95%CI:1.317~256.743),高出生体重为保护因素(OR=0.996,95%CI:0.993~0.999)。为排除同卵双胎儿对性别因素的影响,剔除11对同卵双胎儿和1对同异卵情况不详病例后进行多因素分析,结果仍提示女性为危险因素(OR=18.527,95%CI:1.209~283.820),高出生体重为保护因素(OR=0.996,95%CI:0.992~1.000)。结论女性和出生体重是生后11~20 d的双胎早产儿之一合并TH的影响因素。Objective To study the factors influencing transient hypothyroxinemia(TH)in one premature twin.Methods This retrospective study enrolled 283 sets of preterm twins who were born at the gestational age of 26-36 weeks and admitted to the Neonatology Department of the Second Affiliated Hospital of Wenzhou Medical University from June 2009 to September 2021.The levels of thyroxine(T4),triiodothyronine(T3)and thyroid stimulating hormone(TSH)were detected at 11-20 d after birth.Finally,47 sets of twins were further analyzed,in which one twin met the diagnostic criteria of TH(TH group,n=47)and the other twin with exclusion of the diagnosis(control group,n=47).Pearson correlation was used to analyze the correlation of T4 with gestational age and birth weight.Paired t test,Wilcoxon signed-rank test or McNemar test,and conditional logistic regression were used to analyze the factors influencing TH in premature twins.Results The gestational age and birth weight of the 47 sets of preterm twins(94 cases)were(31.4±2.3)weeks(26-36 weeks)and(1611.9±389.3)g(800-2510 g),respectively.There were 35 sets of dizygotic twins,11 sets of monozygotic twins,and one set of twins with unknown zygosity.The serum T4 level in premature infants was positively correlated with the gestational age and birth weight(the correlation coefficients were 0.209 and 0.376,respectively,both P<0.05).Univariate analysis showed that compared with the control group,the factors influencing TH in premature infants(P<0.1)included female[29.8%(14/47)vs 14.9%(7/47),χ2=3.27],bronchopulmonary dysplasia[31.9%(15/47)vs 19.1%(9/47),χ2=3.13],birth weight[(1547.9±348.0)vs(1676.0±420.5)g,t=-3.61],white blood cell count[(10.0±3.3)×10^(9)/L vs(10.9±3.3)×10^(9)/L,t=-2.19]and vitamin D level[(42.8±12.1)vs(45.9±16.6)nmol/L,t=-1.76].The data on vitamin D were incomplete and after excluding the factor,the logistic regression showed that female was a risk factor(OR=18.38895%CI:1.317-256.743);while higher birth weight was a protective factor(OR=0.996,95%CI:0.993-0.999).In

关 键 词：甲状腺功能减退症 婴儿 早产 双胎 甲状腺素 促甲状腺素 

分 类 号：R714.21[医药卫生—妇产科学]