先天性甲状腺功能减低症转归的高危因素随访研究

A follow-up study on high-risk factors of congenital hypothyroidism processing

目的探讨新生儿先天性甲状腺功能减低症(congenital hypothyroidism,CH)转归为永久性先天性甲状腺功能减低症的高危因素。方法选取于2016年10月—2021年9月经安徽省合肥市妇女儿童保健中心新生儿疾病筛查中心筛查、确诊的114例CH患儿为研究对象,经过逐步筛选最终入选93例。通过定期随访对患儿母亲孕期情况、患儿出生情况、CH确诊时信息、疾病后续诊疗信息进行调查。规范治疗随访3年后,行停药试验、甲状腺B超、核素扫描等检查以鉴别永久性先天性甲状腺功能减低症(permanent congenital hypothyroidism,PCH)或暂时性先天性甲状腺功能减低症(transient congenital hypothyroidism,TCH)。采用logistic回归分析CH转归为PCH的高危因素。结果CH转归为PCH者33例(35.5%),TCH者60例(64.5%)。确诊时促甲状腺激素(thyroid stimulating hormone,TSH)≥90 uIU/mL、甲状腺B超偏小或缺如是PCH的高危因素,而新生儿性别、所在地区、其母孕期情况等均不是PCH的高危因素。结论确诊时TSH血值高和B超显示甲状腺偏小或缺如是CH患儿转归为PCH的高危因素,临床诊疗医生在日常治疗过程中和停药试验时需要高度关注这两个方面的因素。

Objective To investigate the risk factors of neonatal congenital hypothyroidism(CH)progressing to permanent congenital hypothyroidism.Methods Totally 114 infants with CH who were screened and confirmed by the neonatal disease screening center of the health center of women and children,Anhui Province from October 2016 to September 2021 were selected,and 93 were finally recruited as study subjects.Mothers’gestational situations,neonatal birth conditions,information upon CH diagnosis and following treatment were investigated through regular follow up visit.After 3 years of standardized treatment,drug withdrew test,thyroid B-ultrasound,and nuclear scan were performed to identify permanent congenital hypothyroidism(PCH)or temporary congenital hypothyroidism(TCH).Logistic regression analysis was used to explore risk factors of CH progressing to PCH.Results CH progressed to PCH in 33 patients(35.5%)and TCH in 60 patients(64.5%).Thyroid stimulating hormone(TSH)≥90 uIU/mL and small or absent thyroid detected by B-ultrasound were risk factors of PCH.However,gender,region,and maternal situation during pregnancy were not risk factors of PCH.Conclusion High TSH blood value and small or absent thyroid detected by B-ultrasound are risk factors of CH progressing to PCH.Clinicians should pay close attention to these factors during daily treatment and drug withdrawal experiment.