极低出生体重儿先天性甲状腺功能减低症与住院期间不良结局的关系  

Association between congenital hypothyroidism and in-hospital adverse outcomes in very low birth weight infants

作　　者：朱莎 许静 石然然 王小康 孙毛毛 李士娜[3] 高玲玲 李媛媛[5] 温慧敏 赵常亮[7] 李帅 季娟[9] 杨翠红 于永慧 中国北方新生儿协作网多中心协作组 Zhu Sha;Xu Jing;Shi Ranran;Wang Xiaokang;Sun Maomao;Li Shina;Gao Lingling;Li Yuanyuan;Wen Huimin;Zhao Changliang;Li Shuai;Ji Juan;Yang Cuihong;Yu Yonghui;Sino-Northern Neonatal Network Collaborative Group(Department of Neonatology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250014,China;Department of Neonatology,Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Neonatology,Yantai Yuhuangding Hospital,Yantai 264000,China;Department of Neonatology,Liaocheng People′s Hospital,Liaocheng 252000,China;Department of Neonatology,W.F.Maternal and Child Health Hospital,Weifang 261000,China;Department of Neonatology,Hebei PetroChina Central Hospital,Langfang 065000,China;Department of Neonatology,the Third Hospital of Baogang Group,Baotou 014010,China;Department of Neonatology,the First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China;Department of Neonatology,Feixian People′s Hospital,Linyi 273400,China;不详)

机构地区：[1]山东第一医科大学附属省立医院新生儿科,济南250014 [2]济宁医学院附属医院新生儿科,济宁272000 [3]烟台毓璜顶医院新生儿科,烟台264000 [4]聊城市人民医院新生儿科,聊城252000 [5]潍坊市妇幼保健院新生儿科,潍坊261000 [6]河北中石油中心医院新生儿科,廊坊065000 [7]包钢集团第三职工医院新生儿科,包头014010 [8]山东第一医科大学第一附属医院新生儿科,济南250014 [9]费县人民医院新生儿科,临沂273400 [10]不详

出　　处：《中华儿科杂志》2024年第1期29-35,共7页Chinese Journal of Pediatrics

基　　金：山东省自然科学基金(ZR2023MH175);山东省医学会临床科研资金-齐鲁专项(YXH2022DZX02001)。

摘　　要：目的探讨极低出生体重儿(VLBWI)先天性甲状腺功能减低症(CH)与住院期间不良结局的关系。方法采用多中心前瞻性观察性队列研究,数据来源于中国北方新生儿协作网(SNN),收集并分析2019年1月1日至2022年12月31日37家新生儿重症监护病房(NICU)收治的出生体重<1500 g、出生胎龄24~<37周的5818例VLBWI的临床资料。VLBWI出生后7~10 d首次筛查甲状腺功能,随后每周动态检测至出生后第4周,并于校正胎龄36周或出院前复测,共4次。根据住院期间是否发生CH,分为CH组和非CH组。采用χ^(2)检验或Fisher确切概率法、Wilcoxon秩和检验、单因素和多因素Logistic回归模型,分析CH与住院期间不良结局的关系。结果5818例VLBWI中男2982例(51.3%),出生胎龄30(29,31)周,CH的发生率为5.5%(319例)。在CH组中,仅121例(37.9%)在首次筛查时被检出。单因素Logistic回归分析显示,CH与宫外生长发育迟缓(EUGR)、Ⅲ期及以上早产儿视网膜病变(ROP)的发生率增加均相关[OR=1.31(1.04~1.64)、1.74(1.11~2.75),均P<0.05];进一步进行多因素Logistic回归分析显示,CH与EUGR、中重度支气管肺发育不良、3~4级脑室内出血、Ⅱ期及以上新生儿坏死性小肠结肠炎、Ⅲ期及以上ROP发生率均无相关性[OR=1.04(0.81~1.33)、0.79(0.54~1.15)、1.15(0.58~2.26)、1.43(0.81~2.53)、1.12(0.70~1.80),均P>0.05]。结论VLBWI出生4周内动态检测甲状腺功能可及时诊断CH,积极替代治疗后CH与其住院期间不良结局无显著相关性。Objective To investigate the association between congenital hypothyroidism(CH)and the adverse outcomes during hospitalization in very low birth weight infants(VLBWI).Methods This prospective,multicenter observational cohort study was conducted based on the data from the Sino-northern Neonatal Network(SNN).Data of 5818 VLBWI with birth weight<1500 g and gestational age between 24-<37 weeks that were admitted to the 37 neonatal intensive care units from January 1^(st),2019 to December 31^(st),2022 were collected and analyzed.Thyroid function was first screened at 7 to 10 days after birth,followed by weekly tests within the first 4 weeks,and retested at 36 weeks of corrected gestational age or before discharge.The VLBWI were assigned to the CH group or non-CH group.Chi-square test,Fisher exact probability method,Wilcoxon rank sum test,univariate and multivariate Logistic regression were used to analyze the relationship between CH and poor prognosis during hospitalization in VLBWI.Results A total of 5818 eligible VLBWI were enrolled,with 2982(51.3%)males and the gestational age of 30(29,31)weeks.The incidence of CH was 5.5%(319 VLBWI).Among the CH group,only 121 VLBWI(37.9%)were diagnosed at the first screening.Univariate Logistic regression analysis showed that CH was associated with increased incidence of extrauterine growth retardation(EUGR)(OR=1.31(1.04-1.64),P<0.05)and retinopathy of prematurity(ROP)of stageⅢand above(OR=1.74(1.11-2.75),P<0.05).However,multivariate Logistic regression analysis showed no significant correlation between CH and EUGR,moderate to severe bronchopulmonary dysplasia,gradeⅢtoⅣintraventricular hemorrhage,neonatal necrotizing enterocolitis in stageⅡor above,and ROP in stageⅢor above(OR=1.04(0.81-1.33),0.79(0.54-1.15),1.15(0.58-2.26),1.43(0.81-2.53),1.12(0.70-1.80),all P>0.05).Conclusion There is no significant correlation between CH and in-hospital adverse outcomes,possibly due to timely diagnosis and active replacement therapy.

关 键 词：婴生 极低出生体重 先天性甲状腺功能减低症 预后 队列研究 

分 类 号：R722.6[医药卫生—儿科]