先天性甲状腺功能减退症的围产期危险因素：在中国一家三级医院进行的一项回顾性队列研究。
Perinatal risk factors for congenital hypothyroidism: A retrospective cohort study performed at a tertiary hospital in China.
作者信息
Zhou Jinfu, Luo Jinying, Lin Junyu, Zeng Yinglin, Qiu Xiaolong, Zhu Wenbin, Liu Guanghua
机构信息
Center of Neonatal Screening.
Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical Universitya.
出版信息
Medicine (Baltimore). 2020 Jun 26;99(26):e20838. doi: 10.1097/MD.0000000000020838.
Congenital hypothyroidism (CH) is one of the most common neonatal endocrine diseases. This retrospective cohort study aimed to identify the potential perinatal risk factors for CH and to differentiate between transient and permanent CH (TCH and PCH, respectively) as well as determine their prevalence in a southeastern Chinese population.This study was based on an 18-year surveillance of a neonatal CH screening program in a large tertiary hospital. A retrospective review of the maternal and neonatal perinatal exposures was conducted.Of the 205,834 newborns screened between 2000 and 2018, 189 were diagnosed with CH (1/1089). Among the 131 CH patients who again underwent thyroid function testing (TFT) after discontinuation of levothyroxine at the age of 3 years, 61 (46.6%) were diagnosed with PCH and 70 (53.4%) were diagnosed with TCH. In the maternal characteristics model, women aged 35 years or older and those who had thyroid disease and/or diabetes mellitus during pregnancy had increased risk of having an offspring with CH (P = .001, .000, and .001, respectively). Significant associations were found with regard to parity and the risk of CH in the offspring (P = .000). In the neonatal characteristics model, infants with female sex, preterm birth, post-term birth, low birth weight, other birth defects, and those born as part of multiple births (P = .011, .034, .001, .000, .000, and .003, respectively) had increased risk of CH. The rate of newborns with other birth defects was higher in the PCH group than that in the TCH group (P = .008), whereas the rate of maternal thyroid disease, newborns with low birth weight, and newborns with preterm birth was higher in the TCH group than that in the PCH group (P = .041, .020, and .013, respectively). The levothyroxine dose (μg/kg/day) at 1 year, 2 years, and 3 years old was significantly lower in the TCH group than that in the PCH group (P = .000, .000, and .000, respectively).Perinatal factors should be considered during the diagnosis and treatment of CH.
先天性甲状腺功能减退症（CH）是最常见的新生儿内分泌疾病之一。这项回顾性队列研究旨在确定CH潜在的围产期危险因素，区分暂时性CH和永久性CH（分别为TCH和PCH），并确定其在中国东南部人群中的患病率。本研究基于一家大型三级医院对新生儿CH筛查项目的18年监测。对孕产妇和新生儿的围产期暴露情况进行了回顾性分析。在2000年至2018年期间筛查的205834例新生儿中，189例被诊断为CH（1/1089）。在131例3岁时停用左甲状腺素后再次进行甲状腺功能测试（TFT）的CH患者中，61例（46.6%）被诊断为PCH，70例（53.4%）被诊断为TCH。在孕产妇特征模型中，35岁及以上的女性以及孕期患有甲状腺疾病和/或糖尿病的女性生育CH患儿的风险增加（P分别为0.001、0.000和0.001）。发现产次与后代患CH的风险之间存在显著关联（P = 0.000）。在新生儿特征模型中，女性婴儿、早产、过期产、低出生体重、其他出生缺陷以及多胞胎婴儿患CH的风险增加（P分别为0.011、0.034、0.001、0.000、0.000和0.003）。PCH组中伴有其他出生缺陷的新生儿比例高于TCH组（P = 0.008），而TCH组中孕产妇甲状腺疾病、低出生体重新生儿和早产新生儿的比例高于PCH组（P分别为0.041、0.020和0.013）。TCH组1岁、2岁和3岁时的左甲状腺素剂量（μg/kg/天）显著低于PCH组（P分别为0.000、0.000和0.000）。在CH的诊断和治疗过程中应考虑围产期因素。
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