Hanaoka Shintaro, Iwanaga Kogoro, Tomotaki Seiichi, Niwa Fusako, Takita Junko, Kawai Masahiko
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Clin Endocrinol (Oxf). 2020 Nov;93(5):613-619. doi: 10.1111/cen.14272. Epub 2020 Jul 14.
To examine the effect of antenatal corticosteroids (ANS) on the maturation of thyroid function in the preterm infants.
ANS reduce mortality and morbidities in preterm neonates. Organ maturation by the glucocorticoids is the key, at least in part. However, the effect of ANS on thyroid is controversial.
A study group of 99 very low birthweight neonates (<34 weeks' gestational age) with the exception of those born more than 7 days after ANS administration were divided into a complete group (n = 49) whose mothers completed two doses of betamethasone and who were born more than 24 hours after the completion of ANS administration, and an incomplete group (n = 50) who were not exposed to any ANS or were born within 24 hours after the completion of ANS administration. Serum-free thyroxine and thyroid-stimulating hormone (TSH) levels were measured, and thyrotropin-releasing hormone (TRH) stimulation tests were performed at about 2 weeks of age.
The incidence of hyperthyrotropinaemia (TSH > 15 mIU/L) in the complete group was significantly lower than in the incomplete group (6% vs 22%, P = .023). Exaggerated responses to TRH tests were more frequent in the incomplete group (17% vs 44%; P = .053). TSH was significantly lower in the complete group, (P = .046). Multivariate logistic regression analysis showed that the incidence of hyperthyrotropinaemia was associated with complete ANS administration (adjusted odds ratios 0.39).
ANS administration might facilitate thyroid maturation in preterm neonates.
探讨产前使用糖皮质激素（ANS）对早产儿甲状腺功能成熟的影响。
ANS可降低早产儿的死亡率和发病率。糖皮质激素促进器官成熟是其作用的关键，至少部分如此。然而，ANS对甲状腺的影响存在争议。
选取99例极低出生体重儿（胎龄<34周）作为研究对象，排除在使用ANS后7天以上出生的婴儿，将其分为完整组（n = 49）和不完整组（n = 50）。完整组母亲完成两剂倍他米松治疗，且在完成ANS治疗后24小时以上出生；不完整组未接受任何ANS治疗，或在完成ANS治疗后24小时内出生。在出生后约2周时测量血清游离甲状腺素和促甲状腺激素（TSH）水平，并进行促甲状腺激素释放激素（TRH）刺激试验。
完整组中促甲状腺激素血症（TSH>15 mIU/L）的发生率显著低于不完整组（6%对22%，P = 0.023）。不完整组中对TRH试验的过度反应更为常见（17%对44%；P = 0.053）。完整组的TSH水平显著更低（P = 0.046）。多因素逻辑回归分析显示，促甲状腺激素血症的发生率与完整使用ANS有关（调整后的优势比为0.39）。
使用ANS可能有助于早产儿甲状腺成熟。
