疾病状态早产儿血清FT_(3)、FT_(4)、TSH水平变化及其与疾病转归的关系

Changes of Serum FT_(3),FT_(4) and TSH Levels in Premature Infants Under Disease Status and Their Relationship with Disease Outcome

目的 探讨疾病状态早产儿血清游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺激素(FT_(4))、促甲状腺激素(TSH)水平变化及其与疾病转归的关系。方法 选择2019年1月至2020年2月郑州市第一人民医院新生儿病房的258例疾病状态早产儿作为研究对象,纳入疾病组;另择同期收治的85例未合并疾病的早产儿纳入对照组。采用危重病例评分(NCIS)评估疾病组严重程度,于出生后T_(1)(7~10 d)、T_(2)(14~17 d)时间点测定血清FT_(3),FT_(4)、TSH水平,统计短暂性低甲状腺素血症(TH)及低T_(3)综合征比率,随访观察预后情况。结果 疾病组T_(1)、T_(2)时间点FT_(3)、FT_(4)水平低于对照组,TSH高于对照组(P<0.05);疾病组新生儿TH、低T_(3)综合征比率高于对照组(P<0.05)。危重组新生儿出生后T_(1)、T_(2)时间点FT_(3)、FT_(4)水平低于非危重组(P<0.05)。危重组新生儿TH、低T_(3)综合征比率高于非危重组(P<0.05)。所有患病早产儿均进行预后随访及统计,预后不佳组新生儿出生后T_(1)、T_(2)时间点FT_(3)、FT_(4)低于预后良好组,新生儿TH、低T_(3)综合征比率高于预后良好组(P<0.05)。单因素及多因素分析示,胎龄、出生体重、出生1 min Apgar评分、出生5 min Apgar评分、严重程度、低T_(3)综合征及TH发生是预后不佳的独立危险因素(P<0.05)。结论 疾病状态早产儿甲状腺素水平变化与疾病严重程度相关,TH及低T_(3)综合征可能与早产儿不良预后相关。

Objective To investigate the changes of serum free triiodothyronine(FT_(3)),free thyroid hormone(FT_(4))and thyroid-stimulating hormone(TSH)levels in premature infants under disease status,and their relationship with disease outcome.Methods Totally 258 premature infants under disease status(disease group)and 85 healthy premature infants(control group)were enrolled in this study between January 2019 and February 2020 in the First People’s Hospital of Zhengzhou Neonatal Ward.The severity of the disease was evaluated with the neonatal critical illness score(NCIS).Serum FT_(3),FT_(4) and TSH levels were measured at T_(1)(7-10 days)and T_(2)(14-17 days)after birth.The proportions of transient hypothyroxinemia(TH)and low T_(3) syndrome were counted,and follow-up was carried out to observe the prognosis.Results The levels of FT_(3) and FT_(4) in the disease group at T_(1) and T_(2) were lower than those in the control group(P<0.05).TSH level was higher than that in the control group(P<0.05).The proportions of TH and low T_(3) syndrome in the disease group were higher than those in the control group(P<0.05).The levels of FT_(3) and FT_(4) in the critical group at T_(1) and T_(2) were lower than those in the non-critical group(P<0.05).The proportions of TH and low T_(3) syndrome in the critical group were higher than those in the non-critical group(P<0.05).All premature infants under disease status were followed up,and the prognosis was statistically analyzed.The levels of FT_(3) and FT_(4) in the poor prognosis group at T_(1) and T_(2) were lower than those in the good prognosis group,the proportions of TH and low T_(3) syndrome were higher than those in the good prognosis group(P<0.05).Univariate analysis and multivariate analysis found that gestational age,birth weight,1 minute Apgar score,5 minutes Apgar score,severity,low T_(3) syndrome and TH were independent risk factors for poor prognosis(P<0.05).Conclusion The changes of thyroxine levels in premature infants under disease status are related to the severity of the disease.TH and low T_(3) syndrome may be related to poor prognosis of premature infants.