不同胎龄早产儿甲状腺功能水平变化情况及其相关因素分析

Analysis of thyroid function and clinical factors in premature infants of different gestational age

目的分析不同胎龄早产儿甲状腺功能水平变化情况及其相关因素。方法采用回顾性分析方法选取2014年12月至2017年6月在广东省中山市小榄人民医院新生儿科住院,出生后14 d内检测甲状腺功能五项的早产儿共110例,根据胎龄将研究对象分为胎龄<32周组(36例)、32周≤胎龄<34周组(30例)、34周≤胎龄<37周组(44例)。比较3组甲状腺功能[三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]水平,分析胎龄与早产儿甲状腺功能水平的相关性及早产儿甲状腺功能水平的影响因素。结果 3组早产儿的T4与FT4水平均随着胎龄升高而升高,各组间比较差异均有统计学意义(均P <0.05)。34周≤胎龄<37周组早产儿的T3、TSH与FT3水平均明显高于胎龄<32周组和32周≤胎龄<34周组,差异均有统计学意义(均P <0.05)。早产儿的T3、T4、TSH、FT3、FT4水平与胎龄均呈正相关(r=0.509、0.542、0.319、0.410、0.543,均P <0.001)。多元线性回归分析结果显示,对早产儿T3水平有影响的因素为出生体质量、新生儿败血症和胎龄;对T4水平有影响的因素为胎龄;对TSH水平有影响的因素为出生体质量、孕母甲状腺功能、产式;对FT3水平有影响的因素为出生体质量和胎龄;对FT4水平有影响的因素为胎龄(均P <0.05)。结论早产儿甲状腺功能水平均与胎龄呈正相关。对于胎龄<34周、孕母甲状腺功能异常、存在新生儿败血症等高危因素的早产儿,应在出生后2周复查甲状腺功能,以减少甲状腺功能低下的漏诊。

Objective To analyze the changes of thyroid function in preterm infants with different gestational.Methods From December 2014 to June 2017,110 premature infants admitted to the Department of Neonatology of Xiaolan People’s Hospital of Zhongshan who had thyroid function tested within 14 days after birth were retrospectively analyzed.According to the gestational age,they were divided into three groups:gestational age<32 weeks group(36 cases),32 weeks≤gestational age<34 weeks group(30 cases),34 weeks≤gestational age<37 weeks group(44 cases).The thyroid function[triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)]was compared;the correlation between gestational age and thyroid function level of preterm infants was analyzed.Results The levels of T4 and FT4 of premature infants in the three groups were increased with gestational age;the differences were statistically significant(all P<0.05).The levels of T3,TSH and FT3 in the group of 34 weeks≤gestational age<37 weeks were significantly higher than those in the group of 32 weeks≤gestational age<34 weeks,and the differences were statistically significant(all P<0.05).The levels of T3,T4,TSH,FT3 and FT4 in preterm infants were positively correlated with gestational age(r=0.509,0.542,0.319,0.410,0.543,all P<0.001).The results of multiple linear regression analysis showed that the factors influencing T3 level of preterm infants were birth quality,neonatal sepsis and gestational age.The influencing factor of T4 level was gestational age.The factors influencing TSH level were birth quality,maternal thyroid function and birth type.The factors influencing FT3 level were birth mass and gestational age.The influential factor of FT4 level was gestational age(all P<0.05).Conclusions The thyroid function of preterm infants was positively correlated with gestational age.Premature infants with gestational age<34 weeks,abnormal thyroid function of pregnant women and high risk factors such as neonatal sepsis should be analyzed two weeks after birth to reduce the missed diagnosis of hypothyroidism.