惠州地区不同胎龄早产儿甲状腺功能检测及影响因素分析

Factors affecting thyroid function in premature infants of Huizhou city

目的探讨不同胎龄早产儿甲状腺功能特点及其影响因素。方法选择本院新生儿科2012年1~12月收治的早产儿为研究对象。按胎龄分为28~31周组、32~34周组及35~36周组,选取同期本院产科出生的健康足月新生儿30名为对照组。分别在生后第1天和第14天检测新生儿静脉血血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)以及促甲状腺激素(TSH),并分析其影响因素。结果各组新生儿生后14天血清FT3、FT4、TSH水平均显著低于生后第1天(P<0.05)。35~36周组和对照组生后第1、14天血清FT3、FT4水平均高于28~31周组和32~34周组,32~34周组高于28~31周组(P<0.05)。TSH水平生后第1天35~36周组和对照组高于28~31周组和32~34周组,生后第14天28~31周组和32~34周组高于35~36周组和对照组(P<0.05)。早产儿生后第1天影响甲状腺功能的因素为胎龄、出生体重及窒息、缺氧缺血性脑病、呼吸窘迫征综合征、休克等严重疾病;生后第14天影响因素为胎龄和出生体重。结论早产儿下丘脑-垂体-甲状腺轴发育不成熟,生后14天检测甲状腺功能具有重要临床意义。

Objective To explore the characteristics and affecting factors of thyroid function in premature infants. Methods Premature neonates admitted into the study were divided into four groups based on their gestational ages （ GA ）, including three observation groups of 28 - 31weeks GA （ 28 cases） , 32-34 weeks GA （27 cases）, 35-36 weeks GA （30 cases）, and a control group of 37-41 weeks GA （30 cases）. Serum freetriiodothyronine （F^F3） , free thyroid hormones （FT4 ） and thyroid stimulating hormone （TSH） levels were measured on day 1 ＆ day 14 of age, followed by evaluation of affecting factors. Results Serum Fr3 , Fr4 and TSH levels on day 14 were lower than day lof age in all groups （P 〈 O. 05 ）. In premature infants, FT3 and FT4 levels on the 1 st day and 14th day of life were both higher in infants of more advanced gestational age groups ; ~I＇3 ＆ [~F4 levels in infants of 35-36 weeks GA were higher than those in infants of 32-34 weeks GA; the same trend was also observed when comparing the FF3 and FT4 levels in infants born at 32-34 weeks GA with those born at 31-32 weeks GA （P 〈0. 05）. Although on day 1 of age, TSH levels were higher in infants of 35-36 weeks GA ＆ 37-41 weeks GA than in those of 31-32 weeks GA ＆32-34 weeks GA, this trend was reversed on day 14 of age, with higher TSH levels observed in infants of 31-32 weeks GA ＆32-34 weeks GA （P 〈 0. 05 ）. On the first day of life, gestational age, birth weight, birth asphyxia, HIE, RDS and neonatal shock were found factors affecting thyroid function; whereas by the 14th day of life, thyroid function was only affected by gestational age and birth weight. Conclusions Due to immature hypothalamus-pituitary-thyroid axis in premature infants affecting thyroid function test results, it is necessary to re-evaluate thyroid function at two weeks of life.