新生儿足跟血TSH初筛阳性的危险因素研究

Study on the risk factors for TSH positive in preliminary screening of neonatal heel blood

目的探讨新生儿足跟血促甲状腺激素(TSH)初筛阳性的危险因素。方法选取2020年5月至2022年5月于该院分娩的562例新生儿为研究对象。其中TSH阳性患儿纳入TSH阳性组,TSH阴性患儿纳入健康组。比较两组一般资料(包括性别、胎龄、分娩时间、出生体质量)及母体临床特征[有无妊娠期贫血、血红蛋白水平、有无妊娠期糖尿病、空腹血糖(FBG)水平、有无甲状腺功能减退、有无甲状腺功能亢进和TSH水平、游离三碘甲状腺原氨酸(FT_(3))水平、游离甲状腺素(FT_(4))水平]。采取非条件Logistic逐步回归分析新生儿足跟血TSH初筛阳性的危险因素。绘制受试者工作特征(ROC)曲线分析母体TSH、FT_(3)、FT_(4)对新生儿足跟血TSH初筛阳性的诊断效能。结果TSH初筛结果显示,足跟血TSH初筛阳性共17例(TSH阳性组),另选100例足跟血TSH初筛阴性新生儿为健康组。两组性别、胎龄、分娩时间、母体妊娠期贫血比例、母体血红蛋白水平、母体妊娠期糖尿病比例、母体FBG水平、母体甲状腺功能亢进症比例比较,差异均无统计学意义(P>0.05)。TSH阳性组低体质量新生儿比例、母体甲状腺功能减退比例、母体TSH水平显著高于健康组,母体FT_(3)、母体FT_(4)水平显著低于健康组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素(P<0.05)。ROC曲线结果显示,母体TSH、FT_(3)、FT_(4)诊断新生儿足跟血TSH初筛阳性的曲线下面积分别为0.713、0.718、0.661。结论出生低体质量、母体甲状腺功能减退、母体TSH水平升高、母体FT_(3)水平降低、母体FT_(4)水平降低是新生儿足跟血TSH初筛阳性的危险因素,在筛查时需给予更多关注。

Objective To investigate the risk factors of positive initial screening of thyroid stimulating hormone(TSH)in neonatal heel blood.Methods A total of 562 newborns delivered in the hospital from May 2020 to May 2022 were selected as the study objects.The TSH-positive children were included in the TSH-positive group,and the TSH-negative children were included in the healthy group.General data(including gender,gestational age,delivery time,birth weight)and maternal clinical characteristics[presence or absence of gestational anemia,hemoglobin level,presence or absence of gestational diabetes mellitus,fasting blood glucose(FBG)level,presence or absence of hypothyroidism,presence or absence of hyperthyroidism,and TSH level,free triiodothyronine(FT_(3))level,free thyroxine(FT_(4))lev el]were compared between the two groups.The risk factors of TSH positive initial screening in neonatal heel blood were determined by unconditional Logistic stepwise regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the value of maternal TSH,FT_(3) and FT_(4) in the diagnosis of positive initial screening of TSH in neonatal heel blood.Results Prelimina ry screening results showed that 17 cases of heel blood TSH preliminary screening positive(TSH-positive group),another 100 cases of heel blood TSH preliminary screening negative neonates were selected as healthy group.There were no significant differences in gender,gestational age,delivery time,proportion of maternal anemia during pregnancy,maternal hemoglobin level,proportion of maternal gestational diabetes,maternal FBG level,and proportion of maternal hyperthyroidism between the two groups(P>0.05);while the proportion of low birth weight newborns,the proportion of maternal hypothyroidism and the level of maternal TSH in TSH-positive group were significantly higher than those in healthy group,and the levels of maternal FT_(3) and FT_(4) in TSH-positive group were significantly lower than those in healthy group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression results s howed that low birth weight,maternal hypothyroidism,elevated maternal TSH level,decreased maternal FT_(3) level and decreased maternal FT_(4) level were the risk factors for positive TSH in neonatal heel blood screening(P<0.05).The ROC curve analysis results showed that the area under the curve of initial screening positive TSH in neonatal heel blood diagnosed with maternal TSH,FT_(3) and FT_(4) were 0.713,0.718 and 0.661,respectively.Conclusion Low birth weight,maternal hypothyroidism,elev ated maternal TSH level,decreased maternal FT_(3) level and decreased maternal FT_(4) level are risk factors for positive TSH in neonatal heel blood screening,and more attention should be paid during screening.