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。
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.
关键词
先天性甲状腺功能低下症 /
假阳性 /
小于胎龄儿
Key words
congenital hypothyroidism /
false positive /
small for gestational age infant
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参考文献
[1] 吴薇,罗小平.小于胎龄儿的诊断与临床管理[J].中华全科医师杂志,2023,22(4):353-357.
Wu W,Luo XP. Diagnosis and clinical management of newborns with small for gestational age[J]. Chin J Gen Pract,2023, 22(4):353-357.(in Chinese)
[2] 中华人民共和国卫生健康委员会.不同胎龄新生儿出生时生长评价标准[EB/OL].(2022-08-18)[2024-03-24]. http://www.nhc.gov.cn/wjw/fyjk/202208/d6dcc281e9b74db88dc972b34cbd3ec7.shtml.
National Health Commission of the PRC. Growth standard for newborns by gestational age[EB/OL].(2022-08-18)[2024-03-24]. http://www.nhc.gov.cn/wjw/fyjk/202208/d6dcc281e9b74db88dc972b34cbd3ec7.shtml.(in Chinese)
[3] Franco B, Laura F, Sara N, et al. Thyroid function in small for gestational age newborns: A review[J]. Journal of Clinical Research in Pediatric Endocrinology, 2013,5(Suppl 1):2-7.
[4] Bosch-Giménez VM, Palazón-Bru A, Blasco-Barbero Á,et al. Multivariate analysis of thyrotropin in preterm newborns based on adequacy of weight for gestational age[J].Thyroid(New York, N.Y.), 2017,27(1):12-124.
[5] Uchiyama A, Watanabe H, Nakanishi H, et al. Small for gestational age is a risk factor for the development of delayed thyrotropin elevation in infants weighing less than 2 000G[J].Clin Endocrinol, 2018,89(4):431-436.
[6] Liu C, Wang K, Guo J, et al. Small for gestational age is a risk factor for thyroid dysfunction in preterm newborns[J]. BMC Pediatrics, 2020,20(1):179.
[7] Jo HY, Yang EH, Kim YM, et al. Incidence of congenital hypothyroidism by gestational age: A retrospective observational study[J].J Yeungnam Med Sci, 2023,40(1):30-36.
[8] Kaluarachchi DC, Nicksic VB, Allen DB, et al Thyroid hormone function in small for gestational age term newborns[J].J Pediatr,2021,238:181-186.
[9] Grob F, Gutierrez M, Leguizamon L, et al. Hyperthyrotropinemia is common in preterm infants who are born small for gestational age[J]. J Pediatr Endocrinol Metab, 2020,33(3):375-382.
[10] Yan XWLC. Analysis of risk factors and screening results of neonatal congenital hypothyroidism in a tertiary care center of Southern China[J].J Multidiscip Health,2023(16):741-749.
[11] 黄敏,洪艳,曹玲雅,等.妊娠期甲状腺功能异常对新生儿甲状腺激素水平的影响[J].中国妇幼保健, 2024,39(8):1442-1445.
Huang M, Hong Y, Cao LY, et al. Effect of thyroid dysfunction during pregnancy on neonatal thyroid hormone levels[J].Maternal and Child Health Care of China, 2024,39(8):1442-1445.(in Chinese)
[12] Abbasi R, Harari-Kremer R, Haim A, et al. Risk factors of congenital hypothyroidism in israel[J]. The Israel Medical Association Journal, 2022,25(12):808.
[13] 杨丽涓,欧明才,张钰,等.四川片区先天性甲状腺功能减低症发病率季节性分析[J].四川医学,2018,39(9):1027-1030.
Yang LJ, Ou MC, Zhang Y, et al. Seasonal analysis of congenital hypothyroidism morbidity in Sichuan[J].Sichuan Medical Journal, 2018,39(9):1027-1030.(in Chinese)
[14] 王雪侠,党晨滢. 2017—2020年郑州地区新生儿先天性甲状腺功能减低症初筛阳性率变化及受季节影响的情况分析[J].河南医学研究,2021,30(18):3429-3430.
Wang XX, Dang CY. Analysis of the change in the positive rate of screening for congenital hypothyroidism in neonates in Zhengzhou from 2017 to 2020 and the influence of season[J]. Henan Medical Research, 2021,30(18):3429-3430.(in Chinese)
[15] 张秋月,刘素娜,吕书博,等.季节变化对河南省新生儿先天性甲状腺功能减低症筛查结果和TSH切值影响的情况分析[J].医药论坛杂志,2023,44(9):36-40.
Zhang QY, Liu SN, Lv SB, et al. Analysis of influence of seasonal variation on the screening results of congenital hypothyroidism and TSH cut-off value of newborns in Henan province[J].J Medical Forum, 2023,44(9):36-40.(in Chinese)
[16] Di Dalmazi G, Carlucci MA, Semeraro D, et al. A detailed analysis of the factors influencing neonatal TSH: Results from a 6-year congenital hypothyroidism screening program[J].Front Endocrinol, 2020,11:456.
[17] 滕晓慧.孕妇年龄与妊娠高危因素及妊娠结局的关系[D].广州:南方医科大学,2018.
Teng XH.The relationship among maternal age, risk factors and pregnancy outcomes: A retrospective cohort study[D].Guangzhou:Southern Medical University,2018.(in Chinese)
[18] 郭兆明,熊英.早产儿甲状腺功能的研究进展[J].临床误诊误治,2018,31(10):110-113.
Guo ZM, Xiong Y. The research progress of thyroid function in preterm neonates[J].Clinical Misdiagnose & Mistherapy, 2018,31(10):110-113.(in Chinese)
[19] 李政秀,曾卫强.新生儿早期甲状腺功能异常减退的研究进展[J].中国当代医药,2023,30(24):42-46.
Li ZX, Zeng WQ. Research progress on early hypothyroidism in newborns[J].China Modern Medicine,2023,30(24):42-46.(in Chinese)
[20] Kaluarachchi DC, Allen DB, Eickhoff JC, et al. Increased congenital hypothyroidism detection in preterm infants with serial newborn screening[J]. J Pediatr, 2019,207:220-225.
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