34周以下早产儿促甲状腺激素延迟升高及影响因素

doi:10.12372/jcp.2023.22e1648

摘要/Abstract

摘要：

目的评估<34周早产儿促甲状腺激素延迟升高（dTSH）的相关因素。方法回顾性分析2020年3月—2021年9月出生并入住新生儿重症监护室的<34周早产儿的临床资料、初筛和生后15~28天静脉血促甲状腺激素（TSH）结果。结果共纳入441例<34周早产儿，男253例、女188例，平均胎龄（30.0±2.0）周。dTSH 17例（3.9%），其中暂时性高TSH血症7例，先天性甲状腺功能减退症（CH）10例。初筛与生后15~28天，dTSH组的TSH水平均高于正常组，差异有统计学意义（P<0.05）。多因素logistic回归分析发现，使用多巴胺、低出生体重、5分钟 Apgar评分<7是dTSH发生的独立危险因素（P<0.05）。结论 <34周早产儿存在dTSH现象，低出生体重、5分钟低Apgar评分，使用多巴胺更容易出现dTSH，对早产儿应注意甲状腺功能的动态监测。

关键词: 促甲状腺激素, TSH分泌延迟, 新生儿筛查, 早产儿

Abstract:

Objective To evaluate the related factors of delayed thyroid stimulating hormone elevation (dTSH) in premature infants with gestational age <34 weeks. Methods The clinical data, preliminary screening and venous blood thyroid stimulating hormone (TSH) results at 15-28d after birth of preterm infants with gestational age <34 weeks born in Jiangxi Maternal and Child Health Hospital and admitted to intensive care unit from March 2020 to September 2021 were retrospectively analyzed. Results A total of 441 preterm infants (253 boys and 188 girls) with gestational age <34 weeks were included, with an average gestational age of (30.0±2.0) weeks. There were 17 cases of dTSH (3.9%), including 7 cases of transient hyperthyrotropinemia and 10 cases of congenital hypothyroidism (CH). The TSH level in dTSH group was higher than that in normal group at first screening and 15 to 28 days after birth, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that dopamine use, low birth weight and 5-minute Apgar score <7 were independent risk factors for dTSH development (P<0.05). Conclusions Preterm infants with gestational age <34 weeks may present with dTSH. Low birth weight, 5-minute low Apgar score, and use of dopamine are more likely to present dTSH. Attention should be paid to dynamic monitoring of thyroid function in preterm infants.

Key words: thyroid stimulating hormone, delayed thyroid stimulating hormone elevation, newborn screening, premature infant

卢晓燕, 陈绍红, 陈影影, 周文俊, 周婵, 宋燕, 李禄全, 唐文燕. 34周以下早产儿促甲状腺激素延迟升高及影响因素[J]. 临床儿科杂志, 2023, 41(10): 675-679.

LU Xiaoyan, CHEN Shaohong, CHEN Yingying, ZHOU Wenjun, ZHOU Chan, SONG Yan, LI Luquan, TANG Wenyan. Related factors affecting delayed thyroid stimulating hormone elevation in preterm infants with gestational age <34 weeks[J]. Journal of Clinical Pediatrics, 2023, 41(10): 675-679.

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参考文献 26

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病例	疾病	15~28 d甲状腺功能测定			用药2周甲状腺功能测定
病例	疾病	TSH/mIU·L^-1	FT₄/ng·dL^-1	FT₃/ng·dL^-1	TSH/mIU·L^-1	FT₄/ng·dL^-1	FT₃/ng·dL^-1
1	CH	24.0	<0.4	<1.1	10.0	1.1	1.6
2	CH	>100.0	<0.4	1.9	15.9	0.9	2.1
3	CH	>100.0	<0.4	2.6	3.7	1.5	3.1
4	CH	53.2	0.5	1.7	23.0	0.7	2.8
5	CH	67.6	0.5	1.6	34.4	0.7	2.2
6	CH	69.9	0.5	2.1	0.7	1.6	2.2
7	CH	54.1	0.5	1.8	20.2	0.5	2.3
8	CH	28.5	0.6	1.9	8.8	1.3	3.6
9	CH	68.3	0.6	1.6	93.9	0.8	2.6
10	CH	28.1	0.6	1.9	15.9	0.9	2.1
11	暂时性高TSH血症	28.6	0.7	1.5	34.6	0.7	1.8
12	暂时性高TSH血症	21.8	0.7	1.5	2.0	1.5	2.5
13	暂时性高TSH血症	31.7	0.8	2.0	5.6	1.1	1.8
14	暂时性高TSH血症	28.1	0.8	1.8	5.4	1.0	1.8
15	暂时性高TSH血症	23.7	0.9	2.5	12.2	1.0	2.1
16	暂时性高TSH血症	21.8	0.9	1.9	15.6	0.9	2.1
17	暂时性高TSH血症	20.3	1.1	4.1	5.7	1.2	2.2

因素	正常组 (n=424)	dTSH 组 (n=17)	统计量	P
一般资料
男性[n(%)]	246(58.0)	7(41.2)	χ²=1.90	0.169
胎龄($\bar{x}±s$) /周	30.2±1.9	29.1±2.4	t=2.32	0.021
出生体重($\bar{x}±s$) /kg	1.4±0.3	1.1±0.3	t=3.90	<0.001
小于胎龄儿[n(%)]	140(33.0)	8(47.1)	χ²=0.47	0.479
多胎[n(%)]	129(30.4)	6(54.5)	χ²=0.17	0.679
剖宫产[n(%)]	285(67.2)	14(82.3)	χ²=1.70	0.192
母源性因素[n(%)]
胎膜早破(≥18 h)	167(39.3)	9(52.9)	χ²=1.31	0.253
糖尿病	102(24.0)	4(23.5)	χ²=0.00	1.000
妊娠期高血压	29(6.8)	2(11.8)	χ²=0.11	0.740
产前激素促肺成熟	228(53.8)	8(47.1)	χ²=0.32	0.572
患有甲状腺疾病	16(3.8)	2(11.8)	χ²=1.00	0.316
产时情况[n(%)]
宫内窘迫	18(42.5)	0(0.0)	χ²=0.08	0.837
1 min Apgar<7分	98(23.1)	6(54.5)	χ²=0.74	0.388
5 min Apgar<7分	21(5.0)	5(29.4)	χ²=13.45	0.002
合并症、并发症及治疗方案[n(%)]
呼吸窘迫综合征	263(62.0)	14(82.3)	χ²=2.82	0.093
败血症	23(5.4)	0(0.0)	χ²=1.02	0.314
支气管肺发育不良	60(14.2)	7(41.2)	χ²=7.45	0.006
坏死性小肠结肠炎	49(11.6)	1(5.9)	χ²=0.12	0.734
早产儿视网膜病	16(3.8)	0(0.0)	χ²=0.66	0.208
脑室周围白质软化	84(20.0)	4(23.5)	χ²=0.14	0.708
使用咖啡因	282(66.5)	15(70.6)	χ²=3.55	0.060
有创机械通气	135(31.8)	13(30.7)	χ²=0.00	1.000
使用糖皮质激素	60(14.1)	5(29.4)	χ²=3.03	0.082
使用多巴胺	322(75.9)	5(12.0)	χ²=15.98	0.001
禁食≥48 h	229(54.0)	16(94.1)	χ²=10.02	0.002

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
使用多巴胺	1.75	0.57	9.43	0.002	5.78(1.89~17.70)
5 min Apgar评分<7分	2.13	0.74	8.25	0.004	8.44(1.97~36.17)
出生体重	-2.84	1.01	7.93	0.005	0.06(0.01~0.42)
常量	-0.73	1.25	0.34	0.558	-