患有相对促甲状腺素血症的早产新生儿脑损伤风险会增加吗？
Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
作者信息
Korzeniewski Steven J, Soto-Rivera Carmen L, Fichorova Raina N, Allred Elizabeth N, Kuban Karl C K, O'Shea T Michael, Paneth Nigel, Agus Michael, Dammann Olaf, Leviton Alan
出版信息
J Pediatr Endocrinol Metab. 2014 Nov;27(11-12):1077-88. doi: 10.1515/jpem-2014-0059.
BACKGROUND
We sought to disentangle the contributions of hyperthyrotropinemia (an indicator of thyroid dysfunction) (HTT) and intermittent or sustained systemic inflammation (ISSI) to structural and functional indicators of brain damage.
METHODS
We measured the concentrations of thyroid-stimulating hormone (TSH) on day 14 and of 25 inflammation-related proteins in blood collected during the first 2 postnatal weeks from 786 infants born before the 28th week of gestation who were not considered to have hypothyroidism. We defined hyperthyrotropinemia (HTT) as a TSH concentration in the highest quartile for gestational age on postnatal day 14 and ISSI was defined as a concentration in the top quartile for gestational age of a specific inflammation-related protein on 2 separate days a week apart during the first 2 postnatal weeks. We first assessed the risk of brain damage indicators by comparing 1) neonates who had HTT to those without (regardless of ISSI) and 2) neonates with HTT only, ISSI only, or HTT+ISSI to those who were exposed to neither HTT nor ISSI.
RESULTS
In univariable models that compared those with HTT to those without, HTT was not significantly associated with any indicator of brain damage. In models that compared HTT only, ISSI only, and HTT+ISSI to those with neither, children with ISSI only or with HTT+ISSI were at significantly higher risk of ventriculomegaly [odds ratios (ORs) 2-6], whereas those with HTT only were at significantly reduced risk of a hypoechoic lesion (ORs 0.2-0.4). Children with HTT only had a higher risk of quadriparesis and those with ISSI alone had a higher risk of hemiparesis (ORs 1.6-2.4). Elevated risk of a very low mental development score was associated with both ISSI only and HTT+ISSI, whereas a very low motor development score and microcephaly were associated with HTT+ISSI.
CONCLUSIONS
The association of HTT with increased or decreased risk of indicators of brain damage depends on the presence or absence of ISSI.
背景
我们试图厘清高促甲状腺素血症（甲状腺功能障碍的一个指标）（HTT）以及间歇性或持续性全身炎症（ISSI）对脑损伤结构和功能指标的影响。
方法
我们测量了786例孕28周前出生且不被认为患有甲状腺功能减退症的婴儿出生后前两周内采集的血液中第14天的促甲状腺激素（TSH）浓度以及25种炎症相关蛋白的浓度。我们将高促甲状腺素血症（HTT）定义为出生后第14天促甲状腺激素浓度处于胎龄最高四分位数，ISSI定义为出生后前两周内每周相隔一天的两天特定炎症相关蛋白浓度处于胎龄最高四分位数。我们首先通过比较1）患有HTT的新生儿与未患HTT的新生儿（无论是否患有ISSI）以及2）仅患有HTT、仅患有ISSI或同时患有HTT+ISSI的新生儿与既未接触HTT也未接触ISSI的新生儿，来评估脑损伤指标的风险。
结果
在将患有HTT的新生儿与未患HTT的新生儿进行比较的单变量模型中，HTT与任何脑损伤指标均无显著关联。在将仅患有HTT、仅患有ISSI以及同时患有HTT+ISSI的新生儿与既未接触HTT也未接触ISSI的新生儿进行比较的模型中，仅患有ISSI或同时患有HTT+ISSI的儿童发生脑室扩大的风险显著更高[比值比（OR）为2 - 6]，而仅患有HTT的儿童出现低回声病变的风险显著降低（OR为0.2 - 0.4）。仅患有HTT的儿童发生四肢瘫的风险更高，仅患有ISSI的儿童发生偏瘫的风险更高（OR为1.6 - 2.4）。极低智力发育评分风险升高与仅患有ISSI以及同时患有HTT+ISSI均相关，而极低运动发育评分和小头畸形与HTT+ISSI相关。
结论
HTT与脑损伤指标风险增加或降低的关联取决于是否存在ISSI。
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