LabPlus, Auckland District Health Board, Newborn Metabolic Screening Programme, Auckland, New Zealand.
Liggins Institute, University of Auckland, Auckland, New Zealand.
Clin Endocrinol (Oxf). 2019 Sep;91(3):456-463. doi: 10.1111/cen.14044. Epub 2019 Jun 11.
Optimal newborn screening thyroid-stimulating hormone (TSH) cut-offs are contentious. Analysis of demographic factors that impact screen TSH levels may help explain international variance and provide guidance to screening programmes.
To determine the influence of demographic factors on newborn screening TSH levels and screening performance parameters.
National, retrospective population study using blood spot TSH cards from the New Zealand newborn screening programme in 2010-2015.
325 685 blood spot cards.
Likelihood of exceeding specific TSH thresholds (TSH ≥5, ≥10 and ≥15 mIU/L) and group-specific screening performance parameters.
The likelihood of high TSH levels differed between ethnic groups. Pacific Island infants were more than twice as likely to have high-normal TSH levels (≥5 and ≥10 mIU/L) and nearly twice as likely to have a positive screen (≥15 mIU/L) as New Zealand Europeans. Māori or Chinese ethnicity, male sex, younger gestational age and greater socio-economic deprivation scores were also associated with high-normal TSH levels. At a TSH threshold ≥15 mIU/L, screening sensitivity was lowest (88.89% vs 95.83% overall) and PPV greatest (88.89% vs 62.84%) amongst Asian infants. Early samples were more than three times as likely to reach the screen-positive threshold and more likely to yield a false-positive result (PPV 20.00% vs 68.87%, P = 0.004).
Newborn TSH levels are impacted by a number of demographic variables, particularly ethnicity and age at sample collection. Screening performance may be improved through the use of targeted thresholds.
最佳新生儿筛查促甲状腺激素（TSH）切点存在争议。分析影响筛查 TSH 水平的人口统计学因素，有助于解释国际间的差异，并为筛查项目提供指导。
确定人口统计学因素对新生儿筛查 TSH 水平和筛查性能参数的影响。
使用 2010-2015 年新西兰新生儿筛查计划的血斑 TSH 卡进行全国性、回顾性人群研究。
325685 个血斑卡。
超过特定 TSH 阈值（TSH≥5、≥10 和≥15mIU/L）的可能性以及特定组的筛查性能参数。
不同种族之间 TSH 水平升高的可能性不同。与新西兰欧洲人相比，太平洋岛民婴儿出现高正常 TSH 水平（≥5 和≥10mIU/L）的可能性高出两倍以上，出现阳性筛查（≥15mIU/L）的可能性也高出近两倍。毛利人或华人血统、男性、较小的胎龄和较大的社会经济剥夺评分也与高正常 TSH 水平相关。在 TSH 阈值≥15mIU/L 时，筛查敏感性最低（88.89%，而总体为 95.83%），阳性预测值最高（88.89%，而总体为 62.84%）。亚洲婴儿的早期样本达到阳性筛查阈值的可能性高出三倍以上，并且更有可能出现假阳性结果（阳性预测值 20.00%，而总体为 68.87%，P=0.004）。
新生儿 TSH 水平受多种人口统计学变量影响，特别是种族和样本采集时的年龄。通过使用有针对性的阈值，可提高筛查性能。
