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目的探讨早产、感染、病理性黄疸及窒息4种新生儿常见病因对甲状腺功能的影响。方法选择2012年4月至2014年4月本院新生儿病房收治的入院日龄<7天,至少有早产、窒息、病理性黄疸、感染一种因素的新生儿为观察组;选择同期在本院产科出生、日龄5~7天的足月健康新生儿为对照组。两组新生儿均在出生5~7天时抽取静脉血2 ml,检测血清游离碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺素(TSH)。观察组患儿病情稳定后复查甲状腺功能。比较观察组与对照组及观察组不同病因与对照组新生儿的甲状腺功能,以及观察组病情稳定后与出生5~7天时的甲状腺功能。结果观察组220例,对照组34例。生后5~7天,观察组及各病因组FT3均低于对照组,差异有统计学意义(P<0.05),各组FT4和TSH差异无统计学意义(P>0.05);感染组中重症组FT4、FT3低于轻症组,小胎龄早产组和危重黄疸组FT3分别低于大胎龄早产组和中度黄疸组,差异有统计学意义(P<0.05)。观察组病情稳定后血清FT3高于出生5~7天,差异有统计学意义(P<0.05),FT4及TSH与出生5~7天比较差异无统计学意义(P>0.05),与对照组FT3、FT4及TSH比较差异均无统计学意义(P>0.05)。多因素分析显示,新生儿出生5~7天FT3受胎龄、病理性黄疸、感染及窒息等因素影响较明显(P<0.05),受分娩方式和性别影响较小(P>0.05)。结论早产、感染、病理性黄疸和窒息对新生儿早期甲状腺功能的影响主要表现为暂时性FT3降低,严重感染时,还可能引起暂时性FT4降低,但病情稳定后甲状腺功能可恢复正常。
Objective To investigate the effects of common causes of thyroid function in four neonates with premature birth, infection, pathological jaundice and asphyxia. Methods From April 2012 to April 2014, the hospital admission neonatal ward was admitted to hospital for less than 7 days. At least neonates with preterm birth, asphyxia, pathological jaundice and infection were selected as the observation group. Obstetrics and Gynecology birth, full-term healthy neonates aged 5 to 7 days for the control group. Neonates in both groups were drawn 2 ml of venous blood 5 to 7 days after birth, and serum free iodine thyroid acid (FT3), free thyroxine (FT4) and thyrotropin (TSH) were measured. Observed children with stable disease after review of thyroid function. The thyroid function of neonates in different etiology and control group of observation group and control group and observation group were compared, and the thyroid function of the observation group was stable after 5 ~ 7 days of birth. Results The observation group of 220 cases, control group of 34 cases. The FT3 in the observation group and each etiology group were lower than those in the control group (P <0.05), but there was no significant difference between FT4 and TSH in each group (P> 0.05) FT3 and FT3 in severe group were lower than those in mild group, FT3 in preterm birth group and critical jaundice group were lower than those in preterm birth group and moderate jaundice group, respectively (P <0.05). The serum level of FT3 in the observation group was higher than that in the first 5 to 7 days after birth (P <0.05), while there was no significant difference between FT4 and TSH in the first 5-7 days (P> 0.05) There was no significant difference between FT3, FT4 and TSH (P> 0.05). Multivariate analysis showed that FT3 was significantly affected by gestational age, pathological jaundice, infection and asphyxia 5 to 7 days after birth (P <0.05), and was less affected by the mode of delivery and sex (P> 0.05). Conclusions The effects of premature delivery, infection, pathological jaundice and asphyxia on early thyroid function in neonates are mainly temporary FT3 decrease. In severe infection, transient FT4 may also be reduced, but thyroid function may return to normal after the condition is stabilized.