新生儿足跟血促甲状腺激素水平的影响因素

Influential Factors on the TSH Level in the Heel Blood of the Neonates

目的探讨新生儿先天性甲状腺功能低下症(CH)筛查的检测方法,新生儿出生季节对碘营养状况正常的新生儿足跟血促甲状腺激素(TSH)测定值的影响。方法采集新生儿出生后72 h足跟血(血片),酶联免疫吸附测定(ELISA),时间分辨荧光免疫(TRFIA)法检测TSH,应用χ2检验比较2种检测方法和出生季节对TSH水平及CH发生率的影响。结果ELISA法新生儿筛查TSH>5 mU/L(16.16%、2003年)的比率与其他碘缺乏病(IDD)监测指标明显分离;TRFIA法2004、2005年TSH>5 mU/L比率分别为2.84%、2.77%,达到WHO/UNICEF/ICC IDD的碘营养状况正常的标志(TSH>5mU/L的比率<3%)。发现夏季新生儿TSH>5 mU/L的比率显著低于1 a中其他3个季节(P<0.05);统计61例CH病儿,CH发生率以秋冬季节为高(P<0.05)。结论TRFIA法筛查新生儿CH,其TSH水平可作为评价人群碘营养状况指标,新生儿出生季节对TSH水平和CH发生率有一定影响。

[Objective] To explore the testing method for CH screening and the influence of birth season on the TSH level in the heel blood of the neonates who had normal iodine nutrition. [ Methods] ELISA and TRFIA were applied to test the TSH level of the heel blood collected from the neonates 72 hours after birth; X^2 test was carried out to evaluate the influence the two methods and birth season on the TSH level and occurrence rate of CH. [ Results] The percentage of neonatal TSH over 5mu/L （ 16.16%, 2003 ） tested by ELISA were apparently inconsistent with other test indicators of IDD, but that tested by TRFIA in 2004 and 2005 were 2.84% and 2.77% respectively, which accorded with the normal standard for the iodine nutrition signs of WHO/UNICEF/ICCIDD （ the ratio of TSH 〉 5mu/L was lower than 3% ） ; the percentage of neonatal TSH over 5mu/L in summer was remarkably lower than that in other three seasons （P〈0.05）; the incidence of CH among the 61 cases of CH children was high in autumn and winter （ P 〈0. 05 ）. [ Conclusion] The TSH level of neonatal CH screened by TRFIA can be used as an indicator to appraise the population iodine nutrition status; the birth season has some influence on the TSH level and the incidence of CH.