暂时性低甲状腺素血症与低T3综合征对早产儿临床情况的影响

Influence of Transient Hypothyroxinemia and Low T3 Syndrome on Clinical Circumstance of Premature Infants

目的了解暂时性低甲状腺素血症(TH)与低T3综合征对早产儿住院期间临床情况的影响。方法选取笔者医院新生儿科收住的出生胎龄为26～36周的早产儿422例,于出生后12～16天检测血清T3、T4、TSH。按甲状腺功能分为TH组、低T3综合征组和正常对照组。收集患儿的临床资料并进行统计学分析。结果 TH组的住院时间、光疗时间、血红蛋白最低值、恢复出生体重时间、开奶时间、静脉营养时间、机械通气率、吸氧时间与对照组相比,有显著性差异,TH组的早产儿较对照组住院时间更长,黄疸情况更重,肠内营养不易耐受,需要静脉营养的时间更长,体重增长更慢,机械通气率更高,需要吸氧的时间更长,更容易发生早产儿贫血;低T3综合征组的光疗时间、静脉营养时间与对照组相比,有显著性差异,低T3综合征组的早产儿较对照组黄疸情况更重,需要静脉营养的时间更长。结论低T3综合征对早产儿住院期间的黄疸情况和营养状况产生影响。TH对早产儿住院期间的黄疸情况、营养状况、呼吸系统及血液系统等多个方面产生影响,增加住院期间的并发症,延长住院时间,对临床情况的影响较低T3综合征更大,合并TH的早产儿更需要甲状腺素替代治疗。

Objective To investigate the influence of transient hypothyroxinemia（TH） and low T3 syndrome on clinical circum- stance of premature infants during their hospitalization. Methods We selected 422 premature infants whose gestational age were between 26 -36 weeks. Serum thyroxine （T4）, triiodothyronine （T3） and thyroid stimulating hormone （TSH） of them were detected on day 12 - 14 after birth. The premature infants were divided according to their serum T4, T3 and TSH into 3 groups （TH, low T3 syndrome and control group）. Then clinical data of them was collected for statistical analysis. Results There was significant difference in lowest hemo- globin value, time to regain birth weight, time to start enteral nutrition, rate of mechanical ventilation, and duration of hospitalization, phototherapy, parenteral nutrition and oxygen between the TH group and control group. In TH group, jaundice was more serious, weight gained more slowly, hospitalization, parenteral nutrition and administration of oxygen lasted longer, and more likely to occur feeding intolerance and anemia of prematurity and more likely to need mechanical ventilation compared to control group. There was significant difference in duration of phototherapy and parenteral nutrition between the low T3 syndrome group and control group. In low T3 syndrome group, jaundice was more serious, parenteral nutrition lasted longer compared to control group. Conclusion Low T3 syndrome affects jaundice and nutritional status of premature infants. TH affects respiratory system, blood system, jaundice and nutritional status of prema- ture infants. TH can increase risk of complications, and extend hospital stay. It has a greater impact on clinical circumstance of premature infants during their hospitalization than low T3 syndrome. Premature infants with TH need thyroxine replacement therapy more.