目的 分析应用甲状腺激素对轻度高促甲状腺激素(TSH)血症新生儿预后的影响,为临床上治疗轻度新生儿高促甲状腺素(TSH)血症提供理论依据。方法 回顾性分析福建省立医院新生儿重症监护室收治的轻度高TSH血症新生儿资料。根据是否治疗分为治疗组与对照组,比较治疗组与对照组发展为永久性甲状腺功能减退症的情况以及不同阶段Gesell量表评分、身长、体重及甲状腺功能正常的情况。结果 共纳入470例轻度高促甲状腺素血症新生儿,治疗组182例,对照组288例。治疗组胎龄、出生体重、出生身长、头围均小于对照组(Z=-6.600、-6.140、-5.444、-6.537,P＜0.05),合并新生儿感染、新生儿呼吸窘迫综合征、支气管肺发育不良、病情危重发生率高于对照组,差异有统计学意义(χ2=8.755、34.285、19.044、29.235,P＜0.05)。经过倾向性得分匹配后,共匹配成功148例,两组间的基线资料差异无统计学意义(P＞0.05),倾向性得分匹配后两组均无发展为永久性甲减的病例,Gesell量表评分及体重在12、24、36月龄差异均无统计学意义(P＞0.05),治疗组1个月、3个月内甲状腺功能恢复正常的病例数少于对照组,差异有统计学意义(χ2=21.765、8.601,P＜0.05)。结论 对轻度高促甲状腺激素血症患者进行补充甲状腺激素可影响患者3个月内甲状腺功能恢复正常,因此不建议对轻度高促甲状腺素血症的新生儿进行补充甲状腺激素。
Abstract
Objective To analyze the effect of thyroid hormone on the prognosis of newborns with mild hyperthyrotropinemia, so as to provide theoretical basis for clinical treatment of mild neonatal hyperthyrotropinemia. Methods Clinical data of newborns with mild hyperthyrotropinemia admitted to the Neonatal Intensive Care Unit in Fujian Provincial Hospital were retrospectively analyzed. According to treatment or not, newborns were divided into treatment group and control group. The rate of permanent hypothyroidism, Gesell Developmental Schedules(GDS) score, body length, body weight and normal thyroid function in different stages were compared between the treatment group and control groups. Results A total of 470 infants with mild hyperthyrotropinemia were enrolled in the study, including 182 cases in treatment group and 288 cases in control group. The gestational age, birth weight, body length and head circumference of newborns in the treatment group were significantly lower than those in control group(Z=-6.600,-6.140,-5.444,-6.537, P＜0.05).The prevalence rates of neonatal infection, neonatal respiratory distress syndrome, bronchopulmonary dysplasia and critical condition in the control group were significantly higher than those in the control group(χ2=8.755, 34.285, 19.044, 29.235, P＜0.05). Finally, 148 pairs of cases were matched successfully by propensity score matching (PSM). There was no significant difference in baseline data between the two groups (P>0.05). After PSM, neither the treatment group nor the control group had cases developing permanent hypothyroidism, and there were no significant differences in the score of GDS and body weight between the two groups (P>0.05). The number of cases whose thyroid function returned to normal within 1 month and 3 months in the treatment group was significantly less than that in the control group(χ2=21.765,8.601, P＜0.05). Conclusions Thyroid hormone supplementation in newborns with mild hyperthyrotropinemia can prolong the duration of thyroid function level returning to normal range within three months. Therefore, it is not recommended to supplement mild hyperthyrotropinemia infants with thyroid hormoneation.
关键词
高促甲状腺素血症 /
永久性甲减 /
Gesell发育量表 /
新生儿
Key words
hyperthyrotropinemia /
permanent hypothermia /
Gesell Developmental Schedules /
neonates
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