新生儿先天性甲减伴生理性黄疸消退延迟的观察

Observation on the Delayed Clearance of Physiological Jaundice in Neonates with Congenital Hypothyroidism

目的:部份先天性甲减新生儿伴有生理性黄疸消退延迟。本文探讨了其发生与甲减程度的关系。方法:新生儿经时间分辨荧光免疫法筛查,血清TSH>9μIU/ml者,以电化学发光法检测血清TSH、FT3、FT4水平,并观察其生理性黄疸消退状况。结果:共有163名新生儿确诊患有先天性甲减(诊断标准:血清TSH>0.27～4.2μIU/ml,FT4<12～22pmol/L),其中伴有黄疸消退延迟的为67例(41.4%)。消退延迟儿的生理性黄疸程度较深(胆红素水平:足月儿>205.2μmol/L,早产儿>257.0μmol/L)。先天性甲减儿的血清FT3水平不一定低于正常范围(2.8～7.1μmol/L)。在消退迟延组中,FT3低于正常值者有31例(46.27%),而在不伴有黄疸消退延迟组(96例)中,FT3低于正常者只有13例(13.54%)。总的说来,消退延迟组的血清FT3、FT4水平均显著低于正常消退组的水平(P<0.01)。结论:先天性甲减新生儿中,伴有生理性黄疸消退延迟的,其甲状腺功能更为低下。对先天性甲减患儿,必须密切监测其黄疸消退状况。伴有消退延迟者须及时治疗,以免发生胆红素脑病。

Objective Part of neonates with congenital hypothyroidism were accompanied with delayed clearance of physiological jaundice. This article studied the relationship between the occurrence of prolonged jaundice with severity of hypothyroidism. Methods Neonates were screened with DELFIA and those with blood TSH 〉 9μIU/ml were examined for serum FT3, FT4 and TSH levels with ECLIA. The degree and duration of physiological jaundice were noticed. Results Diagnosis of congenital hypothyroidism was eonfirvned in 163 neonates （criteria： serum FT4 〈 12 -22pmol/L, TSH 〉0.27 -4.2μIU/ml）, 67 （41.1%） of them were accompanied with delayed clearance of physiological jaundice. Jandice was also deeper in these neonates （full term 〉 205.2μmol/L, pre -term 〉 257.01μmol/ L）. Serum FT3 levels were not necessary lower than normal （2.8 -7. 1μmol/L） in hypothyroid neonates. Serum FT3 levels were below normal in 31 （46.27%） of the 67 hypothyroid neonates with prolonged jaundice but serum FT3 levels were below normal only in 13 （ 13. 54% ） of the 96 hypothyroid neonates without prolonged jaundice. As a whole, serum FT3 and FT4 levels in hypothyroid neonates accompartied with delayed elearaneo of physiological jaundice were significantly lower than those in hypothyroid neonates without prolonged jaundice （P 〈0.01 ）. Conclusion Thyroid function in congenital hypothyroid neonates accompanied with delayed clearance of physiological jaundice was inferior to that in hypothyroid neonates without prolonged jaundice. Clearance of jaundice must be carefully monitored in congenital hypothyroid neonates for implement of necessary treatment to avoid the development of bilirubin encephalopathy.