34周以下早产儿促甲状腺激素延迟升高及影响因素

Related factors affecting delayed thyroid stimulating hormone elevation in preterm infants with gestational age< 34 weeks

目的 评估<34周早产儿促甲状腺激素延迟升高(dTSH)的相关因素。方法 回顾性分析2020年3月—2021年9月出生并入住新生儿重症监护室的<34周早产儿的临床资料、初筛和生后15~28天静脉血促甲状腺激素(TSH)结果。结果 共纳入441例<34周早产儿,男253例、女188例,平均胎龄(30.0±2.0)周。dTSH 17例(3.9%),其中暂时性高TSH血症7例,先天性甲状腺功能减退症(CH)10例。初筛与生后15~28天,dTSH组的TSH水平均高于正常组,差异有统计学意义(P<0.05)。多因素logistic回归分析发现,使用多巴胺、低出生体重、5分钟Apgar评分<7是dTSH发生的独立危险因素(P<0.05)。结论 <34周早产儿存在dTSH现象,低出生体重、5分钟低Apgar评分,使用多巴胺更容易出现dTSH,对早产儿应注意甲状腺功能的动态监测。

Objective To evaluate the related factors of delayed thyroid stimulating hormone elevation(dTSH) in premature infants with gestational age <34 weeks.Methods The clinical data,preliminary screening and venous blood thyroid stimulating hormone(TSH) results at 15-28d after birth of preterm infants with gestational age <34 weeks born in Jiangxi Maternal and Child Health Hospital and admitted to intensive care unit from March 2020 to September 2021 were retrospectively analyzed.Results A total of 441 preterm infants(253 boys and 188 girls) with gestational age 34 weeks were included,with an average gestational age of(30.0±2.0) weeks.There were 17 cases of dTSH(3.9%),including <7 cases of transient hyperthyrotropinemia and 10 cases of congenital hypothyroidism(CH).The TSH level in dTSH group was higher than that in normal group at first screening and 15 to 28 days after birth,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that dopamine use,low birth weight and 5-minute Apgar score< 7 were independent risk factors for dTSH development(P<0.05).Conclusions Preterm infants with gestational age <34 weeks may present with dTSH.Low birth weight,5-minute low Apgar score,and use of dopamine are more likely to present dTSH.Attention should be paid to dynamic monitoring of thyroid function in preterm infants.