极低/超低出生体重儿甲状腺功能减退的临床分析

张慧; 崔蕴璞; 韩彤妍; 童笑梅; 贾琼; 周颖; 姜雅楠

doi:10.7499/j.issn.1008-8830.2005085

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中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (10) : 1073-1078. DOI: 10.7499/j.issn.1008-8830.2005085

论著·临床研究

极低/超低出生体重儿甲状腺功能减退的临床分析

张慧, 崔蕴璞, 韩彤妍, 童笑梅, 贾琼, 周颖, 姜雅楠

作者信息 +

A clinical analysis of hypothyroidism in very low birth weight/extremely low birth weight infants

ZHANG Hui, CUI Yun-Pu, HAN Tong-Yan, TONG Xiao-Mei, JIA Qiong, ZHOU Ying, JIANG Ya-Nan

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文章历史 +

摘要

目的分析极低/超低出生体重（VLBW/ELBW）患儿甲状腺功能减退的危险因素和治疗情况。方法选择2018年9月至2019年12月诊断为甲状腺功能减退的VLBW/ELBW患儿为病例组（n=29），按照1：3比例匹配甲状腺功能正常的VLBW/ELBW患儿作为对照组（n=87），比较两组患儿的临床特征，分析甲状腺功能与出生胎龄、出生体重的相关性及甲状腺功能减退的危险因素。结果符合纳入标准的VLBW/ELBW患儿共162例，其中病例组29例，甲状腺功能减退发生率为17.9%。出生体重越低，甲状腺功能减退发生率越高（P < 0.05）；三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）与出生胎龄呈正相关（P < 0.05），T3、游离甲状腺素（FT4）与出生体重呈正相关（P < 0.05）。小于胎龄儿、多胎、孕母≥35岁、使用多巴胺是发生甲状腺功能减退的独立危险因素（P < 0.05）。病例组中16例患儿给予左旋甲状腺素（每日5~10 μg/kg）治疗，甲状腺功能在治疗2周后恢复正常。结论 VLBW/ELBW患儿甲状腺功能减退的发生率较高，小于胎龄儿、多胎、孕母高龄、应用多巴胺是其发生甲状腺功能减退的危险因素，应用左旋甲状腺素治疗的患儿需定期随访，以保证用药剂量适宜。

Abstract

Objective To study the risk factors and treatment outcome of hypothyroidism in very low birth weight/extremely low birth weight (VLBW/ELBW) infants. Methods The VLBW/ELBW infants who were diagnosed with hypothyroidism from September 2018 to December 2019 were enrolled as the case group (n=29). The children with normal thyroid function, matched at a ratio of 1:3, were enrolled as the control group (n=87). Clinical features were compared between the two groups. The correlation of thyroid function with gestational age and birth weight and the risk factors for hypothyroidism were analyzed. Results A total of 162 VLBW/ELBW infants who met the inclusion criteria were enrolled, with 29 infants in the case group (an incidence rate of hypothyroidism of 17.9%). The lower the birth weight, the higher the incidence rate of hypothyroidism (P < 0.05). Triiodothyronine (T3) and free T3 were positively correlated with gestational age (P < 0.05). T3 and free thyroxine were positively correlated with birth weight (P < 0.05). Small for gestational age, multiple birth, maternal age ≥ 35 years, and use of dopamine were independent risk factors for hypothyroidism (P < 0.05). In the case group, 16 infants were treated with levothyroxine (5-10 μg/kg daily), and the thyroid function returned to normal after 2 weeks of treatment. Conclusions There is a high incidence rate of hypothyroidism in VLBW/ELBW infants. Small for gestational age, multiple birth, advanced maternal age, and use of dopamine are risk factors for hypothyroidism. The infants treated with levothyroxine should be followed up regularly to ensure an appropriate dose.

导出引用

张慧, 崔蕴璞, 韩彤妍, 童笑梅, 贾琼, 周颖, 姜雅楠. 极低/超低出生体重儿甲状腺功能减退的临床分析[J]. 中国当代儿科杂志. 2020, 22(10): 1073-1078 https://doi.org/10.7499/j.issn.1008-8830.2005085

ZHANG Hui, CUI Yun-Pu, HAN Tong-Yan, TONG Xiao-Mei, JIA Qiong, ZHOU Ying, JIANG Ya-Nan. A clinical analysis of hypothyroidism in very low birth weight/extremely low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics. 2020, 22(10): 1073-1078 https://doi.org/10.7499/j.issn.1008-8830.2005085

参考文献

[1] Jacob H, Peters C. Screening, diagnosis and management of congenital hypothyroidism:European Society for Paediatric Endocrinology Consensus Guideline[J]. Arch Dis Child Educ Pract Ed, 2015, 100(5):260-263.
[2] Chung HR, Shin CH, Yang SW, et al. High incidence of thyroid dysfunction in preterm infants[J]. J Korean Med Sci, 2009, 24(4):627-631.
[3] Lee JH, Kim SW, Jeon GW, et al. Thyroid dysfunction in very low birth weight preterm infants[J]. Korean J Pediatr, 2015, 58(6):224-229.
[4] Scratch SE, Hunt RW, Thompson DK, et al. Free thyroxine levels after very preterm birth and neurodevelopmental outcomes at age 7 years[J]. Pediatrics, 2014, 133(4):e955-e963.
[5] Chung HR. Screening and management of thyroid dysfunction in preterm infants[J]. Ann Pediatr Endocrinol Metab, 2019, 24(1):15-21.
[6] La Gamma EF, van Wassenaer AG, Ares S, et al. Phase 1 trial of 4 thyroid hormone regimens for transient hypothyroxinemia in neonates of <28 weeks' gestation[J]. Pediatrics, 2009, 124(2):e258-e268.
[7] 刘俐, 姜忒. 早产儿甲状腺功能减退[J]. 中华新生儿科杂志, 2019, 34(2):151-154.
[8] Uchiyama A, Kushima R, Watanabe T, et al. Effect of l-thyroxine supplementation on infants with transient hypothyroxinemia of prematurity at 18 months of corrected age:randomized clinical trial[J]. J Pediatr Endocrinol Metab, 2015, 28(1-2):177-182.
[9] American Academy of Pediatrics, Rose SR, Section on Endocrinology and Committee on Genetics, et al. Update of newborn screening and therapy for congenital hypothyroidism[J]. Pediatrics, 2006, 117(6):2290-2303.
[10] Sun X, Lemyre B, Nan X, et al. Free thyroxine and thyroid-stimulating hormone reference intervals in very low birth weight infants at 3-6 weeks of life with the Beckman Coulter Unicel DxI 800[J]. Clin Biochem, 2014, 47(1-2):16-18.
[11] 中华医学会儿科学分会内分泌遗传代谢学组, 中华预防医学会儿童保健分会新生儿疾病筛查学组. 先天性甲状腺功能减低症诊疗共识[J]. 中华儿科杂志, 2011, 49(6):421-424.
[12] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第4版. 北京:人民卫生出版社, 2011:340-344, 401-402, 395-398.
[13] van Wassenaer AG, Kok JH. Hypothyroxinaemia and thyroid function after preterm birth[J]. Semin Neonatol, 2004, 9(1):3-11.
[14] Williams FL, Simpson J, Delahunty C, et al. Developmental trends in cord and postpartum serum thyroid hormones in preterm infants[J]. J Clin Endocrinol Metab, 2004, 89(11):5314-5320.
[15] 陈浪辉, 张伟忠, 黄太伟, 等. 惠州地区不同胎龄早产儿甲状腺功能检测及影响因素分析[J]. 中国新生儿科杂志, 2014, 29(4):238-241.
[16] Zung A, Bier Palmon R, Golan A, et al. Risk factors for the development of delayed TSH elevation in neonatal intensive care unit newborns[J]. J Clin Endocrinol Metab, 2017, 102(8):3050-3055.
[17] 罗春伟, 赵德华, 梁歌, 等. 母亲相关因素与新生儿先天性甲状腺功能减低症易感性的病例对照研究[J]. 中国当代儿科杂志, 2020, 22(1):37-41.
[18] Alimohamadi Y, Taghdir M, Sepandi M. Statistical data analysis of the risk factors of neonatal congenital hypothyroidism in Khuzestan Province, Iran[J]. Data Brief, 2018, 21:2510-2514.
[19] Kaluarachchi DC, Allen DB, Eickhoff JC, et al. Increased congenital hypothyroidism detection in preterm infants with serial newborn screening[J]. J Pediatr, 2019, 207:220-225.
[20] Vigone MC, Caiulo S, Di Frenna M, et al. Evolution of thyroid function in preterm infants detected by screening for congenital hypothyroidism[J]. J Pediatr, 2014, 164(6):1296-1302.
[21] Hashemipour M, Hovsepian S, Ansari A, et al. Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates:a systematic review[J]. Pediatr Neonatol, 2018, 59(1):3-14.
[22] Bongers-Schokking JJ, Resing WC, de Rijke YB, et al. Cognitive development in congenital hypothyroidism:is overtreatment a greater threat than undertreatment?[J]. J Clin Endocrinol Metab, 2013, 98(11):4499-4506.
[23] van Wassenaer AG, Westera J, Houtzager BA, et al. Ten-year follow-up of children born at <30 weeks' gestational age supplemented with thyroxine in the neonatal period in a randomized, controlled trial[J]. Pediatrics, 2005, 116(5):e613-e618.