巴西塞尔希培州永久性先天性甲状腺功能减退症的诊断预测因素及其时间变化——一项真实世界的回顾性研究。
Predictive factors for the diagnosis of permanent congenital hypothyroidism and its temporal changes in Sergipe, Brazil - A real-life retrospective study.
机构信息
Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil.
Departamento de Medicina, Universidade Federal de Sergipe, Aracaju, SE, Brasil.
出版信息
Arch Endocrinol Metab. 2023 Mar 10;67(2):189-196. doi: 10.20945/2359-3997000000579. Epub 2023 Jan 17.
OBJECTIVE
Congenital hypothyroidism (CH) can be permanent (PCH) or transient (TCH). While the importance of thyroxine in myelination of the brain is undisputed, the benefits to neurodevelopmental outcomes of TCH treatment are controversial. Our objectives were to determine predictive factors for PCH and verify its prevalence changes over time.
SUBJECTS AND METHODS
A total of 165 children were evaluated at 3 years of age to verify the diagnosis of PCH. 130 were submitted to a two-step cluster analysis, with the aim of grouping them into homogeneous clusters. The mean incidence of PCH and TCH was calculated from 2004 to 2010 and 2011 to 2015.
RESULTS
Sixty-six children were diagnosed with PCH, and 99 were diagnosed with TCH. Eighty-one percent of PCH children and all TCH children with thyroid imaging had glands . Eighty children (61.5%) were in Cluster 1, 8 children (6.2%) were in Cluster 2 and 42 children (32.3%) were in Cluster 3. No children had PCH in Cluster 1, while 87.5% of children in Cluster 2 and all children in Cluster 3 had PCH. The most important predictor for PCH was the initial serum TSH, which was marginally higher in importance than the blood spot TSH, followed by the initial serum free T4. The mean incidence of PCH (odds ratio: 1.95, 95% CI 1.36 to 2.95, p < 0.0001) and TCH (odds ratio 1.33, 95%, CI 1.02 to 1.77, p = 0,038) increased over time.
CONCLUSION
The most important PCH predictors are the initial serum TSH and the blood spot TSH. The mean incidence of both PCH and TCH in our series increased.
目的
先天性甲状腺功能减退症（CH）可分为永久性（PCH）或暂时性（TCH）。虽然甲状腺素在脑髓鞘形成中的重要性是毋庸置疑的，但 TCH 治疗对神经发育结果的益处仍存在争议。我们的目的是确定 PCH 的预测因素，并验证其随时间的变化。
对象和方法
共 165 名儿童在 3 岁时进行评估，以确定 PCH 的诊断。其中 130 名儿童接受了两步聚类分析，旨在将他们分为同质的聚类。从 2004 年至 2010 年和 2011 年至 2015 年，计算 PCH 和 TCH 的平均发病率。
结果
66 名儿童被诊断为 PCH，99 名儿童被诊断为 TCH。81%的 PCH 儿童和所有有甲状腺成像的 TCH 儿童的腺体都存在。80 名儿童（61.5%）在聚类 1 中，8 名儿童（6.2%）在聚类 2 中，42 名儿童（32.3%）在聚类 3 中。聚类 1 中没有儿童患有 PCH，而聚类 2 中 87.5%的儿童和聚类 3 中的所有儿童均患有 PCH。预测 PCH 的最重要因素是初始血清 TSH，其重要性略高于末梢血 TSH，其次是初始血清游离 T4。PCH（比值比：1.95，95%置信区间 1.36 至 2.95，p <0.0001）和 TCH（比值比 1.33，95%置信区间 1.02 至 1.77，p = 0.038）的平均发病率随时间增加。
结论
预测 PCH 的最重要因素是初始血清 TSH 和末梢血 TSH。我们系列中 PCH 和 TCH 的平均发病率均增加。
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