小于胎龄儿对新生儿先天性甲状腺功能减低症发病及筛查假阳性的影响

doi:10.11852/zgetbjzz2024-0698

摘要/Abstract

摘要： 目的探究小于胎龄儿(SGA)对新生儿先天性甲状腺功能减低症(CH)发病及筛查假阳率的影响,为降低CH发病及筛查假阳性率提供参考。方法选取2018年1月—2022年12月于佛山市妇幼保健院分娩的孕妇及其新生儿为研究对象,通过医院信息系统采集研究对象的一般资料及妊娠期合并症、新生儿情况及采血情况。研究共纳入孕妇及新生儿56 903对,按新生儿出生体重及胎龄情况分为SGA组和对照组。采用χ²检验比较研究组与对照组的一般情况差异,采用二元Logistic回归分析SGA对CH发病率及CH筛查假阳性率的影响。结果 SGA与对照组在母亲高龄、妊娠期合并贫血、妊娠期糖尿病、妊娠期高血压、辅助生殖、多胎、低出生体重、冬季采血方面差异有统计学意义(χ²=38.38、34.17、17.04、166.04、5.94、357.14、5 328.85、5.26,P＜0.05)。调整混杂因素以后,妊娠期甲状腺功能异常是新生儿CH的危险因素(OR=2.811,95%CI:1.319~5.988,P＜0.05)。SGA(OR=1.253,95%CI: 1.103~1.423)、妊娠期甲状腺功能异常(OR=2.135,95%CI: 1.878~2.428)、女性新生儿(OR=1.111,95%CI: 1.024~1.205)、冬季采血(OR=1.474,95%CI: 1.347~1.612)是新生儿CH初筛假阳性的危险因素(P＜0.05);高龄(OR=0.874,95%CI: 0.768~0.995)、多胎(OR=0.619,95%CI: 0.456~0.839)和早产(OR=0.454,95%CI: 0.356~0.580)则为初筛假阳性的保护因素(P＜0.05)。结论 SGA、妊娠期甲状腺功能疾病、女性新生儿、冬季采血会增加CH筛查假阳性风险。建议根据母婴情况制定不同的筛查切值,避免因CH筛查假阳性给新生儿及其家庭造成不必要的经济和精神负担。

关键词: 先天性甲状腺功能低下症, 假阳性, 小于胎龄儿

Abstract: Objective To explore the impact of small for gestational age(SGA) infants on the incidence and screening false positive rate of congenital hypothyroidism(CH) in newborns, in order to provide reference for reducing the incidence of CH and the screening false positive rate. Methods Pregnant women and their newborns who delivered at Foshan Maternity and Child Healthcare Hospital from January 2018 to December 2022 were selected as the study subjects. General information, pregnancy complications, newborn conditions, and blood collection details were collected through the hospital information system. A total of 56 903 pairs of pregnant women and newborns were included in the study and were divided into the SGA group and the control group based on the newborns′ birth weight and gestational age. Thetest was used to compare the differences in general characteristics between the study and control groups. Binary Logistic regression analysis was conducted to assess the impact of SGA infants on the incidence of CH and the false positive rate of CH screening. Results There were significant differences in the proportions of advanced maternal age, anemia during pregnancy, gestational diabetes, gestational hypertension, assisted reproduction, multiple births, low birth weight, and blood collection in winter between SGA infants and control group(χ²=38.38, 34.17, 17.04, 166.04, 5.94, 357.14, 5 328.85, 5.26, P<0.05). After adjusting for confounding factors, thyroid dysfunction during pregnancy was a risk factor for CH in newborns(OR=2.811, 95%CI:1.319 - 5.988, P<0.05). SGA infants(OR=1.253,95%CI:1.103 - 1.423), thyroid dysfunction during pregnancy(OR=2.135, 95%CI: 1.878 - 2.428), female newborns(OR=1.111, 95%CI:1.024 - 1.205), blood collection in winter(OR=1.474, 95%CI: 1.347 - 1.612) were risk factors for false positives in neonatal CH screening(P<0.05),while advanced maternal age(OR=0.874, 95%CI: 0.768 - 0.995), multiple births(OR=0.619, 95%CI: 0.456 - 0.839) and premature birth(OR=0.454, 95%CI: 0.356 - 0.580) were protective factors of false positives in CH screening(P<0.05). Conclusions SGA infants, thyroid dysfunction during pregnancy, female newborns, and blood collection in winter increase the risk of false positives in CH screening. It is recommended to establish different screening thresholds based on the specific conditions of mothers and infants to optimize the utilization of health resources and avoid unnecessary economic and psychological burdens on newborns and their families due to false positives in CH screening.

Key words: congenital hypothyroidism, false positive, small for gestational age infant

中图分类号:

R179

何瑞雪, 苏晞, 黄湘, 陈文芳. 小于胎龄儿对新生儿先天性甲状腺功能减低症发病及筛查假阳性的影响[J]. 中国儿童保健杂志, 2025, 33(6): 675-680.

HE Ruixue, SU Xi, HUANG Xiang, CHEN Wenfang. Effect of small for gestational age on incidence and false-positive screening of congenital hypothyroidism in newborns[J]. Chinese Journal of Child Health Care, 2025, 33(6): 675-680.

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