新生儿TSH筛查在碘缺乏病监测中的应用

采用灵敏的免疫放射法筛查了9 251例新生儿滤纸血斑TSH水平,以监测贵州省的碘缺乏病。结果在贵阳、都匀和凯里三地区分别有39.22％、36.04％和38.80％的新生儿TSH水平升高(≥5mIU/L),但绝大多数为轻度升高(5～19.9％mlU/L。)。对TSH≥25mlU/L者追踪发现其可在2～30周中恢复正常(<5mlU/L)。新生儿暂时性高TSH血症者增多的状况,表明该地区仍有轻度碘缺乏存在。新生儿TSH筛查是监测碘缺乏病的更敏感指标。     

甲状腺自身抗体阳性妇女孕期干预对婴儿甲状腺功能的影响

目的 探讨甲状腺自身抗体阳性妇女孕期甲状腺功能干预对婴儿甲状腺功能的影响.方法选择产前检查发现的甲状腺过氧化物酶抗体(TPOAb)和(或)甲状腺球蛋白抗体(TgAb)阳性妊娠妇女55例.随机分为干预组(子代为A)36例和非干预组(子代为B)19例,设同期自身抗体阴性对照组(子代为N)30例.选择左旋甲状腺素片作为干预制剂.采用化学发光酶免疫分析法测定3组入选后和分娩前空腹血清TPOAb、TgAb、TSH、TT3、TT4、FT3、FT4水平,同时测定母体尿碘含量.新生儿出生后测定脐血、出生后3～4周及8～10周静脉血TSH、TT3、TT4、FT3、FT4水平.结果干预组、非干预组母体基线血清TSH水平显著高于对照组(P＜0.05).分娩前非干预组与另两组比较,血清TSH增高和TT3、TT4、FT4降低具有统计学差异(P＜0.05或P＜0.01).胎儿出生后脐血TSH水平在B组(7.06±1.31)mIU/L和A组(6.23±1.26)mIU/L均显著高于N组(5.48±1.17)mIU/L(P＜0.01或P＜0.05).出生3～4周新生儿B组血清TSH(3.21±0.70)mIU/L高于N组[(2.72±0.51)mIU/L]和A组[(2.78±0.42)mIU/L,均P＜0.05].出生8～10周婴儿B组血清TSH[(2.99±0.57)mIU/L]高于N组[(2.48±0.68)mIU/L,P＜0.05].多元逐步回归分析,母体TSH、TPOAb及尿碘含量与婴儿TSH独立相关.结论不同甲状腺功能状态的妊娠妇女,其子代出生后的甲状腺功能存在差异.胎儿出生后甲状腺功能与母亲甲状腺自身抗体及孕期甲状腺功能状态有关.     

新疆乌鲁木齐地区人群碘摄人量与甲状腺疾病的相关研究

目的 了解乌鲁木齐地区人群目前碘营养状况、甲状腺疾病流行情况并探讨两者的关系.方法 对新疆乌鲁木齐地区1693名成人进行体格检查、问卷调查,并测定平均尿碘中位数、甲状腺功能、甲状腺相关抗体和进行甲状腺B超检查.结果 在调查人群中,碘缺乏人数仅占9.5％,而碘过量人数达到30.0％.平均尿碘中位数达254.9 μg/L.碘充足/超足量组TT4水平明显高于其他两组[(9.02±2.63)对(7.69±2.85)、(8.45±2.13)μg/dl,均P＜0.05],碘缺乏组TSH水平显著高于其他两组[(3.00±1.86)对(2.37±1.91)、(2.27±1.86) mIU/L,均P＜0.01].各组甲状腺球蛋白抗体、甲状腺过氧化物酶抗体阳性率及甲状腺功能异常、甲状腺结节患病率没有统计学差别.结论 目前新疆乌鲁木齐地区碘缺乏状态已纠正,平均尿碘中位数254.9 μg/L.不同碘摄入状态人群甲状腺疾病患病率无统计学差别.     

消除碘缺乏病评估指标相关性的研究

目的研究碘营养充足状态下新生儿脐带血与足跟血TSH水平间及其同母体孕期尿碘的关系。方法选取河南省碘营养良好地区(居民户盐碘>20 mg／kg,8～10岁儿童尿碘中位数≥100 mg/L,8～10岁儿童B超法甲状腺肿大率<5％)作为调查点,收集孕妇妊娠各个不同时期的尿样测定尿碘。采集新生儿脐带血和足跟血,采用酶免疫分析和放射免疫分析方法测定TSH水平。结果采集不同时期孕妇尿样956份,尿碘中位数255．4μg/L,最小值为32．6μg／L,最大值为2 153．0μg／L。采集新生儿脐带血合格样品289人份,TSH均值为2-32 mU／L;采集新生儿足跟血合格样品246人份,TSH均值为1．22 mU／L,脐带血与足跟血TSH相比差异有统计学意义(t=2．645,P<0．01)。在孕期尿碘≥100μg／L的母亲中,其新生儿脐带血TSH>5mU／L所占比例<3％,新生儿足跟血TSH也显示同样结果。结论孕期碘营养良好是保证新生儿脐带血TSH达标的前提条件,在孕期碘营养良好状态下,盐碘、尿碘、甲状腺肿大率和新生儿脐带血TSH各项指标间将会保持良好的相关关系,以新生儿脐带血TSH作为监测指标可以更灵敏的反映人群的碘营养状态。     

福建省新生儿足跟血促甲状腺激素水平分析

目的：了解福建省特需人群（育龄及孕产妇女）的碘营养水平。方法：新生儿出生后72h采足跟血，滴在规定的滤纸上。采用时间分辨荧光免疫测量法（DELFIA法）测定促甲状腺激素（TSH）浓度。1998－2000年共测定福建省9个地区56家医院正常新生儿足跟血91677例。结果：福建省新生儿TSH中位数为2．82mU/L，TSH值＞5u/U/L者占14．85％。3年间 差异无 显著意义（F＝1．88，P＞0．05），但地区间差异存在显著意义（F＝38．38，P＜0．01）。结论：该人群仍存在缺碘问题，对孕妇和0－2岁婴幼儿的碘营养监测和补碘工作仍需加强。建议在新生儿足跟血TSH＞5mU/L的比率＜3％的基础上建立脐带血TSH的切值。     

新生儿足跟血TSH水平作为人群碘营养指标的探讨

目的探讨新生儿足跟血TSH水平筛查作为人群碘营养状况评价指标的可行性。方法采集新生儿出生后72h的足跟血(血片),ELISA法检测促甲状腺激素(TSH);配对采集孕妇尿样及其新生儿足跟血血样,分别测定尿碘和TSH。结果随着该市人群碘营养状况的改善,新生儿TSH的总水平逐年下降(P<0.01)。2003年TSH第97百分位数(P97)为7.68mU/L,≥5mU/L的比例为16.16%;碘营养正常孕妇出生的新生儿TSH≥5mU/L比例为7.21%。结论孕妇碘营养状况是影响新生儿TSH水平的重要因素;采用ELISA法检测新生儿足跟血TSH水平以评价人群碘营养状态,切点值以TSH≥10mU/L的比例<3%较合适。     

宿迁地区健康新生儿甲状腺功能正常参考值的研究

目的建立宿迁地区健康新生儿甲状腺功能正常参考值。方法入组健康新生儿500名,抽取72 h 足跟血测定足跟血 TSH。入组200名健康新生儿,出生后14 d 抽取静脉血,检测血清 TT3、TT4、TSH、FT3、FT4。同期选取健康成人120名,检测血清 TT3、TT4、TSH、FT3、FT4。结果本地区健康新生儿72 h 足跟血 TSH 参考范围为0.46~6.59 mIU/ L,14 d 血清 TT3、TT4、TSH、FT3、FT4参考范围分别为1.10~2.62 nmol/ L、81.10~158.28 nmol/ L、0.83~6.39 mIU/ L、3.76~6.66 pmol/ L、10.67~22.27 pmol/ L。与成年人相比较,TSH 差别无统计学意义,TT3、TT4、FT3、FT4差异有统计学意义。结论建立健康新生儿甲状腺功能参考范围值有助于了解新生儿出生后的甲状腺功能水平,根据新生儿72 h 足跟血的 TSH 参考值,建议下调初筛先天性甲状腺功能减退症的切点,以减少其临床漏诊率。     

子痫前期患者甲状腺功能变化观察

目的观察子痫前期(PE)孕妇甲状腺功能的变化。方法 174例子痫前期患者,其中轻度PE 83例,重度PE 91例,另选择301例正常妊娠晚期妇女为正常对照组。采用电化学发光技术(ECL)检测血清TSH、FT4、TPO-Ab水平。结果 PE组TSH为2.69(0.58～12.88)mIU/L、FT4为12.13(8.65～17.06)pmol/L、TPOAb为12.55(5.0～98.36)IU/mL,正常对照组分别为2.14(0.56～6.89)mIU/L、12.52(9.30～17.14)pmol/L、8.03(5～21.96)IU/mL,两组患者TSH、FT4、TPOAb相比P均<0.05。PE组轻度PE患者TSH为2.41(0.66～7.77)mIU/L、FT4为12.80(9.27～17.95)pmol/L、TPOAb为13.30(5.0～102.79)IU/mL,重度PE患者分别为3.17(0.14～15.95)mIU/L、11.47(8.53～16.37)pmol/L、11.20(5.0～150.02)IU/mL,轻重度PE患者TSH、FT4、TPOAb相比P均<0.05。子痫前期孕妇血清TSH、TPOAb明显升高、FT4水平明显降低(P均<0.05);与轻度PE相比,重度PE孕妇血清TSH明显升高、FT4水平明显降低(P均<0.05);PE孕妇TPOAb阳性率达12.1%(21/174),与同期筛查组相比P>0.05;子痫前期患者合并各种甲状腺疾病,低T4血症发生率显著高于同期筛查组(P均<0.05)。结论子痫前期患者血清TSH、TPOAb升高、FT4降低。     

秦巴山区孕妇及乳母碘营养状况分析

目的：了解秦巴山区陕西省的柞水,安康2县孕妇及乳母碘营养状况,为研究分析该地区弱智儿童的病因和为\干预措施提供依据。方法：采用酸消化砷铈催化分光光度法测定孕妇及乳母尿碘和母乳碘含量,采用放免分析法测定孕妇及乳母血清T3,T4,TSH含量。结果：柞水,安康2县孕妇及母尿碘中位数分别为235．7ug/L,214.3ug/L,低于国家尿碘标准推荐下限值（100ug/L)者,孕妇占1．6％,乳母占6．7％,T3中位数孕妇为0．7ug/L,乳母为0．6ug/L,低于标准界值（0．8ug/L),孕妇占67．2％,乳母占69．4％,孕妇T4中位数为95．6ug/L,低于正常界值100ug/L 者占58．3％,乳母T4中位数为63．0ug/L,低于正常界值57．0ug/L者占40．3％,TSH结果高于正常界值5．0mU/L者,乳乳母分别占25．0％,23．8％,母乳碘中位数为163．1ug/L,在正常范围,结论;2倒孕妇,乳母人群近期碘入关况良好,但甲状腺各项指标不容乐观,与尿碘分析结果有一定背离,说明体内碘吸收利用状况较差。     

吉林省新生儿先天性甲状腺功能减低症筛查切值研究

目的建立吉林省新生儿先天性甲状腺功能减低症(CH)筛查TSH实验切值。方法新生儿出生72 h后,并充分哺乳,采集足跟血滴于专用滤纸上,采用时间分辨荧光免疫分析方法,检测滤纸干血片TSH浓度。结果测定新生儿足跟血TSH共计30 000例,确定本实验室新生儿TSH切值为9.0 mIU/L。结论 TSH切值为9.0 mIU/L是适合吉林省实际情况的。TSH切值的确定为吉林省今后开展大规模的新生儿CH筛查提供了依据。     

Tg与TSH检测在碘缺乏病监测中的比较研究

通过对新生儿及孕妇Ｔｇ和ＴＳＨ的分析比较，以初步了解它们在碘缺乏疾病（ＩＤＤ）监测中的价值。结果表明：１．新生儿及孕妇Ｔｇ值均＜２０ｎｇ／ｍｌ，无向高值偏移现象，而２９．５％的新生儿和４．３％的孕妇其ＴＳＨ值向＞５ｍＩＵ／Ｌ的高值偏移；２．孕妇尿碘中位数为１２９μｇ／Ｌ，２３％的孕妇其尿碘值＜１００μｇ／Ｌ、作者认为采用新生儿脐血ＴＳＨ测定监测ＩＤＤ似较Ｔｇ更敏感。     

Can neonatal TSH screening reflect trends in population iodine intake?

BACKGROUND: The distribution of neonatal blood thyroid-stimulating hormone (TSH) concentrations has been used as an index reflecting population dietary iodine intake, with higher concentrations being indicative of lower iodine intake. We examined this distribution in neonates born in Ireland, where the pregnant population has shown a recent decline in urinary iodine (UI) excretion. Our objectives were to determine if any alteration was observed in the percentage of values > 5.0 mIU/L and whether a trend in neonatal blood TSH was apparent. METHODS: Samples drawn from the National Neonatal Screening Programme were assessed during the years 1995-2006 from winter (January n = 35,079) and summer (August n = 37,940) months, respectively, in view of the known seasonal variation in Irish dietary iodine intake. RESULTS: Apart from the first years studied (1995-1996), the proportion of individual blood TSH values >5.0 mIU/L did not exceed 3%, a value believed to be indicative of iodine deficiency. A significant declining trend in the proportion of blood TSH >5.0 mIU/L was observed in subsequent years (p < 0.01). While excluding severe iodine deficiency, these analyses failed to detect the slight but highly significant (p < 0.001) tendency toward increasing blood TSH within the 0-5.0 mIU/L interval in the study population between 1999 and 2006, which was greater in summer than in winter months (p < 0.001). CONCLUSIONS: These data support a link between fetal thyroid function and a fall in maternal iodine intake. While the findings of the proportion of blood TSH values >5.0 mIU/L exclude severe maternal or fetal iodine deficiency, a trend toward increasing TSH may provide an early indication of impending iodine deficiency. The findings assume greater importance in the context of declining UI reported from many developed countries even where the proportion of blood TSH values >5.0 mIU/L is <3%, thus excluding severe maternal and fetal iodine deficiency.     

碘缺乏病监测指标的探讨

对５７例新生儿及其孕母配对研究ＴＳＨ、尿碘水平及相关分析。结果：新生儿ＴＳＨ＞５ｍＩＵ／Ｌ者占３２．７％，向高值方向偏移，表明该地区新生儿仍有碘缺乏。新生儿尿碘值与其自身ＴＳＨ水平呈高度负相关（ｒ＝－０．７１，Ｐ＜０．０１），孕母尿碘值与新生儿ＴＳＨ值呈负相关（ｒ＝－０．３４，Ｐ＜０．０５），新生儿尿碘值与其孕母尿碘值呈高度正相关（ｒ＝０．８２，Ｐ＜０．０１）。孕母尿碘值与新生儿尿碘值无显著差异。孕母尿碘值基本反映新生儿尿碘水平。因此，若采用孕母尿碘值作为ＩＤＤ监测指标，可直接反映胎儿和新生儿的碘营养水平，而胎儿和新生儿时期更需要足够碘供应，以保护脑发育，故若采用孕母尿碘值作为ＩＤＤ监测指标更有意义。     

Iodine insufficiency and neonatal hyperthyrotropinaemia in Hong Kong

OBJECTIVES 23% of the neonatal hypothyroidism in Hong Kong is transient. The present study aims to evaluate iodine excretion in healthy pregnant women in Hong Kong and to determine whether iodine insufficiency may occur in the local population to account for the type of neonatal thyroid dysfunction seen in our screening programme. SUBJECTS Pilot screening of urinary iodine excretion was determined in 253 healthy pregnant women between 32 and 36 weeks gestation. Fetal and maternal thyroid function in relation to urinary iodine excretion was evaluated in another 55 pregnant women who had given birth to infants with cord blood TSH ≥ 16 mIU/l (95th percentile of the cord blood TSH screening programme) and the results were compared to a control group of 160 healthy women whose infants had cord blood TSH < 16 mIU/l. RESULTS Using a cut-off value of 0.79 μmol/l, a level as defined by WHO as iodine deficiency, we found that 35.8% of the pregnant women had urinary iodine concentrations below this cut off value. We demonstrated that the existence of borderline iodine supply affected the maternal and fetal thyroid function as evidenced by (i) a negative correlation between maternal TSH and urinary iodine concentration, (ii) higher cord blood TSH in those infants whose mothers had a low urinary iodine concentration as compared to those in whose mothers it was normal, (iii) women who had given birth to infants with cord blood TSH ≥6 mIU/l had lower urinary iodine concentrations and serum fT4 levels as compared to mothers who had given birth to infants with normal cord TSH levels, and their offspring also had higher cord blood thyroglobulin levels. CONCLUSION Although Hong Kong is not a goitrous area, borderline iodine deficiency exists. Iodization of salt in our community could obviate the necessity for iodine supplements in pregnant women and other at-risk groups.     

Maternal and neonatal thyroid function at birth in an area of marginally low iodine intake.

Thyroid function was evaluated in cord serum of healthy full-term newborns and compared to that of mothers immediately after parturition. The study was carried out in an area without overt iodine deficiency, but with a marginal iodine supply (less than 100 micrograms/day in 80% of women). The aim of the study was to delineate the interrelationships between the thyroid statuses of mother and child at birth. Maternal thyroid function was characterized at delivery by relative hypothyroxinemia; increased T3/T4 ratios, indicating preferential T3 secretion; slightly increased TSH levels within the normal range in 97% of women; increased serum thyroglobulin (TG) values, which were above normal in 60% of women; and also goiter formation in almost 10% of women. The findings indicated glandular stimulation and confirmed our earlier reports that pregnancy constitutes a stress for the maternal thyroid economy, enhanced by the limited availability of iodine in the diet. By contrast, newborns showed a strikingly distinct pattern: there was no relative hypothyroxinemia and free T4 levels were significantly higher than in the respective mothers (19.4 vs. 14.7 pmol/L; P less than 0.001). In spite of these differences, however, mean neonatal TSH and TG levels were significantly higher than maternal values, respectively 6.0 vs. 1.9 mU/L for TSH (P less than 0.001) and 70 vs. 40 micrograms/L for TG (P less than 0.001). Furthermore, neonatal TG and TSH levels increased in parallel and were highly correlated with maternal data, suggesting a regulatory link between both thyroid economies. The results suggested that the common regulatory link is the limited availability of the iodine supply. In conclusion, the present study demonstrates that even in conditions with a marginally low iodine intake, pregnancy constitutes a stimulus for both the maternal and newborn thyroids. Changes in both groups are associated and the abnormalities in TSH and TG are amplified in the newborns. The TSH and TG alterations at birth in full-term healthy newborns, associated with similar alterations in maternal thyroid function, provide evidence for a common stimulatory factor, relative iodine deficiency. The data emphasize the hypersensitivity of neonatal thyroid function to marginal iodine deficiency and point to the need to increase the iodine supply in groups at risk, such as women during pregnancy, and also newborns in the perinatal period.     

Neonatal thyrotropin as measured in a congenital hypothyroidism screening program: influence of the mode of delivery

CONTEXT: Many developed countries are reexperiencing iodine deficiency. One World Health Organization index of iodine deficiency in populations is the percentage of neonates with TSH levels greater than 5 mIU/liter 72 h after delivery. Measured TSH levels vary with methodology and are influenced by external factors including iodine exposure at time of delivery. OBJECTIVE: We wished to determine whether babies delivered by cesarean section have higher levels of TSH than babies delivered vaginally because this factor could influence determination of iodine deficiency. DESIGN AND SETTING: This was a cohort study of mothers delivering at a teaching hospital in 2002-2003 and their babies. PATIENTS AND METHODS: Women delivering a live infant were eligible for the study. Demographic data, mode of delivery, and subsequent routine newborn screening TSH levels were recorded. RESULTS: Of 2031 infants, 31.2% were delivered by cesarean section; 1864 babies were born after 37 wk, with blood samples collected by d 5 (>91% on d 3). Significant predictors of TSH concentration were the day TSH was measured and type of delivery. The distribution curve of TSH values was right shifted in infants born by cesarean section. The percentage of neonates born by cesarean with at TSH value greater than 5 was 7.1%. The figure for those born vaginally was 4.3%. CONCLUSIONS: Babies delivered by cesarean section are significantly more likely to have TSH levels greater than 5 mIU/liter on d 3 than those delivered vaginally. With the rise in the rate of births by cesarean, this could be an important factor in assessing population iodine deficiency using neonatal TSH levels.     

不同碘营养水平对育龄妇女甲状腺功能的影响

目的 研究不同碘营养水平对育龄妇女甲状腺功能的影响.方法 选择新疆巩留县和伊宁县各50名育龄妇女(非孕)作为碘充足组和碘缺乏组,按统一设计的调查项目表,逐项询问、检查、填写;内容包括家庭食用盐和饮用水的种类,个人甲状腺疾病史和甲状腺肿大情况.采集调查对象饮用水、食盐、尿液,分别用直接滴定法、砷铈催化分光光度法检测含碘量;采集并用化学发光免疫法检测静脉血清中的TSH、FT4、FT3水平.结果 碘缺乏组和碘充足组碘盐覆盖率分别为72%和100%,前者低于后者(χ2=16.28,P<0.01);尿碘中位数分别为95.5μg/L[四分位间距(QR)=50.0μg/L]和167.4μg/L(QR=186.4μg/L),前者低于后者(U=632.00,P<0.01);血清TSH中位数分别为2.56、1.88 mU/L,前者有高于后者的趋势,但差异无统计学意义(U=990.50,P>0.05);血清FT4分别为(14.7±2.0)、(17.0±3.8)pmoI/L,前者明显低于后者(t=3.76,P<0.01);血清FT3分别为(5.1±1.4)、(4.8±0.5)pmoI/L,二者比较差异无统计学意义(t=1.59,P>0.05);FT3/FT4比值分别为0.33±0.04、0.30±0.04,二者比较差异有统计学意义(t=3.13,P<0.01);甲状腺功能异常检出率分别为20.0%(10/50)、8.0%(4/50),二者比较差异无统计学意义(χ2=2.99,P>0.05).结论 育龄妇女的碘营养缺乏是导致自身甲状腺功能低下的主要原因,坚持长期食用碘盐是彻底纠正机体缺碘状况的最有效方法.     

Postpartum maternal iodine status and the relationship to neonatal thyroid function.

Iodine deficiency in the postpartum period has the potential to affect neonatal neuropsychointellectual development. We performed a cross-sectional study involving 50 postpartum women and their neonates, measuring maternal urine iodine, breast milk iodine, and neonatal thyroid stimulating hormone (TSH), and examining their interrelationships. Women were studied at a median (range) of 4 (3-9) days postpartum. Moderate to severe iodine deficiency (defined by urine iodine concentration < 50 microg/L) was found in 29 of the 50 subjects (58%). The median +/- standard deviation (SD) urine iodine was 46.8 +/- 28.5 microg/L and the mean urine iodine expressed in micrograms per gram of creatinine was 86.6 +/- 45.6. The median (range) breast milk iodine was 84.0 microg/L (25.0-234.0). Breast milk iodine was significantly correlated with urine iodine in micrograms per gram of creatinine (r = 0.52, p < 0.001) but not with urine iodine measured in micrograms per liter (r = 0.19, p = 0.2). Six percent of neonates had whole-blood TSH values of greater than 5 mIU/L. Neonatal TSH levels were positively correlated with higher breast milk iodine (r = 0.42, p = 0.003). There was no significant correlation between neonatal TSH levels and the mother's urine iodine content. There is a high prevalence of iodine deficiency in these lactating postpartum subjects. Urine iodine as micrograms per gram of creatinine is a good predictor of breast milk iodine content. In our study, higher breast milk iodine was correlated with a higher neonatal TSH. The impact of breast milk iodine content on neonatal TSH levels and neuropsychointellectual development needs further study.