新生儿及母亲临床特征对先天性甲状腺功能 减退症筛查的影响

目的 探讨新生儿及母亲临床特征对先天性甲状腺功能减退症（CH）筛查的影响，为避免漏诊CH提供依 据。方法 收集2016年1月—2017年11月足跟血促甲状腺激素（TSH）初筛阳性的新生儿206例，同期1∶1随机抽取 TSH初筛阴性的新生儿206例作为正常对照组，分析2组新生儿性别、胎龄、体质量和母亲合并疾病对CH初筛及确 诊的影响。结果 TSH初筛阳性的新生儿体质量低于初筛正常的新生儿（P＜0.05），而2组新生儿的性别、胎龄，以 及早产、足月产和过期产比例差异无统计学意义。与TSH初筛正常组相比，初筛阳性组的母亲合并甲状腺功能减退 症比例和TSH水平更高，FT3和FT4水平更低（P＜0.05），而2组母亲合并贫血、妊娠糖尿病、亚临床甲状腺功能减退 症及甲状腺功能亢进症的比例，以及血红蛋白、空腹血糖水平差异无统计学意义。与复查为正常的新生儿（198例） 相比，确诊为CH的新生儿（8例）体质量更低，其母亲合并甲状腺功能减退症比例和TSH水平更高，FT3和FT4水平更 低（P＜0.05），而CH组与复查正常组的性别、胎龄、母亲合并亚临床甲状腺功能减退症和甲状腺功能亢进症的比例差 异无统计学意义。结论 新生儿低体质量及母亲合并甲状腺功能减退症影响CH的初筛和确诊，筛查CH时应特别 注意，以避免漏诊。

Effects of clinical features of neonates and mothers on the screening of congenital hypothyroidism

Objective To investigate the clinical features of neonates and mothers on the screening of congenital hypothyroidism (CH), and to provide a basis for avoiding the missed diagnosis of CH. Methods A total of 206 neonates with positive thyroid stimulating hormone (TSH) screening were collected from January 2016 to November 2017, and 206 neonates with negative TSH were randomly selected over the same period as normal control group according to 1∶1 ratio. The impact of neonatal sex, gestational age, body weight and maternal comorbidity on CH screening and diagnosis was analyzed in the two groups. Results The body weight of neonates with positive TSH screening was lower than that of normal newborn infants (P＜0.05), while there were no significant differences in sex, gestational age, the proportion of preterm, mature and post-term delivery between two groups. Compared with normal TSH screening, the proportion of mother with hypothyroidism and TSH level was significantly higher in screening positive group, but FT3 and FT4 levels were lower (P＜0.05). There were no significant differences in the ratio of gestational diabetes mellitus, anemia, subclinical hypothyroidism and hyperthyroidism, hemoglobin and fasting glucose between the two groups of mothers. Compared with confirmed normal group (n=198), the body weight was lower in confirmed CH group (n=8), and the proportion of mother with hypothyroidism and TSH level was significantly higher in confirmed CH group, FT3 and FT4 levels were lower (P＜0.05). There were no significant differences in sex, gestational age, the ratio of subclinical hypothyroidism and hyperthyroidism between CH group and confirmed normal group. Conclusion Neonatal low body weight and maternal hypothyroidism significantly affect the screening and diagnosis of CH. Special attention should be paid to clinical screening of CH in order to avoid missed diagnosis.