极早产儿先天性甲状腺功能减低症围生期危险因素的多中心研究

Perinatal risk factors for congenital hypothyroidism in very preterm infants:a multicenter prospective study

目的分析极早产儿先天性甲状腺功能减低症(CH)的发生率及其围生期危险因素。方法采用多中心前瞻性观察性队列研究,数据来源于多中心极低出生体重儿预后评估协作组所建立的中国北方新生儿协作网(SNN),收集并分析2019年1月至2021年6月33家新生儿重症监护病房(NICU)收治的出生胎龄<32周的3179例极早产儿的临床资料,总结分析其围生期情况和甲状腺功能等。根据住院期间是否发生CH分为CH组和非CH组,采用χ^(2)检验、Fisher确切概率法、秩和检验和多因素Logistic回归模型,分析极早产儿CH发生的危险因素。结果3179例极早产儿中男1793例(56.4%),CH的发生率为6.9%(220例);超低出生体重儿(ELBWI)和出生胎龄<28周超早产儿CH的发生率分别为13.5%(64/475)、13.9%(66/475)。多因素Logistic回归分析显示母亲妊娠期高血压疾病和多胎是CH发生的独立危险因素(OR=1.59、1.60,95%CI 1.14~2.23、1.18~2.17,P=0.007、0.003),出生胎龄、出生体重和1 min Apgar评分是CH发生的保护性因素(OR=0.81、0.99、0.92,95%CI 0.71~0.93、0.98~0.99、0.86~0.98,P=0.002、<0.001、0.008)。结论极早产儿CH发生率较高,出生胎龄、出生体重越低发生率越高;对于存在母亲妊娠期高血压疾病等围生期高危因素的极早产儿,应重视其甲状腺功能状态的动态检测。

Objective To investigate the incidence and perinatal risk factors of congenital hypothyroidism(CH)in very preterm infants.Methods This prospective,multicenter observational cohort study was conducted at 33 neonatal intensive care units based on the data from Sina-northern Neonatal Network(SNN).Perinatal information and thyroid function of 3179 very preterm infants with gestational age<32 weeks who were born from January 2019 to June 2021 was collected.According to the occurrence of CH during hospitalization,all the infants were assigned into CH group and non-CH group.Chi square test,Fisher exact probability method,rank sum test and multivariate Logistic regression model were tested to detect the perinatal risk factors for CH.Results A total of 3179 very preterm infants were enrolled with 56.4%(1793/3179)male.The incidence of CH was 6.9%(220/3179),in which the incidence for extremely low birth weight infant(ELBWI)and extremely preterm infants(EPI)of gestational age<28 weeks were 13.5%(64/475)and 13.9%(66/475),respectively.On Logistic regression analysis,maternal hypertensive disorders of pregnancy(OR=1.59,95%CI 1.14-2.23,P=0.007)and multiple birth(OR=1.60,95%CI 1.18-2.17,P=0.003)were both significant perinatal risk factors of CH.In addition,gestational age(OR=0.81,95%CI 0.71-0.93,P=0.002),birth weight(OR=0.99,95%CI:0.98-0.99,P<0.001)and 1 min Apgar score(OR=0.92,95%CI 0.86-0.98,P=0.008)were protective factors.Conclusions The incidence of CH is high in very preterm infants which increased with the decreased birth weight and gestational age.For very premature infants with perinatal high risk factors such as hypertensive disorders of pregnancy,attention should be paid to assess thyroid function status dynamically.