Yao Yongna, Deng Kui, Zhu Jun, Xiang Liangcheng, Yuan Xuelian, Li Qi, Liu Lei, Xu Weijuan
National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Eur J Pediatr. 2023 Oct;182(10):4477-4486. doi: 10.1007/s00431-023-05108-8. Epub 2023 Jul 26.
Despite the lack of nationwide epidemiological studies, congenital hypothyroidism (CH) incidence in China has increased. We aimed to evaluate the trends of CH and the possible reasons behind them. Data from screened newborns from the Chinese Newborn Screening Information System from 2012 to 2019 was collected. We applied the Bayesian hierarchical Poisson regression model and meta-analysis to estimate incidence or proportion over the years. The estimated CH incidence increased from 4.01 per 10,000 births in 2012 to 5.77 per 10,000 births in 2019. The average annual growth rate (ARG) of CH incidence for all provinces varied from 0.59 to 20.96%. The most rapid rise in incidence was observed in cases with an initial thyroid stimulating hormone (TSH) concentration of < 10 mIU/L. The meta-analysis results showed that the proportion of permanent CH increased by 0.024% (95%CI: 0.011%, 0.037%) annually. Each 1 mIU/L decrease in TSH cutoff value was associated with a 2.96% increase in CH incidence. In the same period, the proportion of premature CH cases increased from 6.60 to 9.10%, which was much higher than the increase in preterm births. A significant relationship was not found between provincial growth rates in screening coverage and provincial baseline incidences of CH. Conclusion: CH incidence has substantially increased in China. The slight adjustment of the TSH cutoff value and increasing preterm birth rate contribute to such a trend; however, the contribution is limited. What is Known: • An uptrend in congenital hypothyroidism (CH) incidence has been reported in many European and American countries in the last two decades; however, no studies have been conducted in China to explain the increased CH incidence. • We provide a detailed epidemiological report on the trends of CH during 2012-2019 in China, with an attempt to explore the reasons behind it. What is New: • This first-ever national-wide epidemiological report in China showed an uptrend in CH incidence with variations over regions and CH subtypes. The mild lowering of TSH cutoff values and the increasing preterm birth rate contributed to this uptrend.
尽管缺乏全国性的流行病学研究，但中国先天性甲状腺功能减退症（CH）的发病率有所上升。我们旨在评估CH的发病趋势及其背后的可能原因。收集了中国新生儿筛查信息系统2012年至2019年筛查新生儿的数据。我们应用贝叶斯分层泊松回归模型和荟萃分析来估计多年来的发病率或比例。估计的CH发病率从2012年的每10000例出生4.01例增加到2019年的每10000例出生5.77例。所有省份CH发病率的年均增长率（ARG）在0.59%至20.96%之间。初始促甲状腺激素（TSH）浓度<10 mIU/L的病例发病率上升最为迅速。荟萃分析结果显示，永久性CH的比例每年增加0.024%（95%CI：0.011%，0.037%）。TSH临界值每降低1 mIU/L，CH发病率增加2.96%。同期，暂时性CH病例的比例从6.60%增加到9.10%，远高于早产率的增加。未发现筛查覆盖率的省级增长率与CH的省级基线发病率之间存在显著关系。结论：中国CH发病率大幅上升。TSH临界值的轻微调整和早产率上升促成了这一趋势；然而，其贡献有限。已知信息：•在过去二十年中，许多欧美国家报告先天性甲状腺功能减退症（CH）发病率呈上升趋势；然而，中国尚未开展研究来解释CH发病率上升的原因。•我们提供了一份关于2012 - 2019年中国CH发病趋势的详细流行病学报告，并试图探究其背后的原因。新发现：•中国首份全国性流行病学报告显示CH发病率呈上升趋势，且存在地区和CH亚型差异。TSH临界值的轻微降低和早产率上升促成了这一上升趋势。
Zotero 插件