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目的探讨正常足月新生儿脐血甲状腺激素的水平,为临床尽早诊断和治疗新生儿甲状腺功能异常疾病提供依据。方法随机选择在复旦大学附属妇产科医院分娩的193例母亲孕期甲状腺功能正常足月新生儿,断脐后采集脐血,通过化学发光免疫分析法测定各项甲状腺激素水平,并同时采集新生儿3天动脉血检测其甲状腺功能,分析新生儿脐血代替3天动脉血甲状腺激素可行性,从而研究脐血甲状腺激素的参考范围。结果 (1)脐血甲状腺激素各项指标参考范围:脐血甲状腺激素为正态分布,TSH(5.375±1.572)、TT3(36.576±8.595)、TT4(8.122±1.019)、FT3(1.657±0.271)、FT4(0.960±0.117)。(2)脐血代替新生儿3天动脉血甲状腺激素具有可行性:脐血和新生儿3天动脉血甲状腺激素五指项标(TSH、TT3、TT4、FT3、FT4)均成正态性分布,新生儿3天动脉血与脐血甲状腺激素均为正相关(P<0.05),TSH、TT3、TT4、FT3、FT4的回归方程分别为Y=84.215+0.067X(P<0.05)、Y=8.765+0.457X(P<0.05)、Y=1.021+1.245X(P<0.05)、Y=1.856+0.272X(P<0.05)、Y=8.765+0.457X(P<0.05),可以用脐血推算新生儿3天动脉血中的甲状腺激素水平。结论用脐血代替具有创伤性的动脉穿刺血分析甲状腺激素水平,既能为患儿家长所接受,也能尽早发现及干预新生儿甲状腺功能异常疾病。
Objective To investigate the level of umbilical blood thyroid hormones in normal term neonates and provide evidence for the early diagnosis and treatment of neonatal hypothyroidism. Methods A total of 193 pregnant women with full-term thyroid function who gave birth during the first trimester of pregnancy were enrolled in the Affiliated Obstetrics and Gynecology Hospital of Fudan University. Umbilical cord blood was collected after the umbilical cord was removed. Thyroid hormone levels were measured by chemiluminescence immunoassay. 3-day arterial blood thyroid function test, analysis of neonatal umbilical cord blood to replace the 3-day arterial thyroid hormone feasibility study of cord blood thyroid hormone reference range. Results: (1) The reference range of umbilical thyroid hormone index: The umbilical blood thyroid hormone was normal distribution, TSH (5.375 ± 1.572), TT3 (36.576 ± 8.595), TT4 (8.122 ± 1.019), FT3 (1.657 ± 0.271) , FT4 (0.960 ± 0.117). (2) Replacement of umbilical cord blood with 3-day arterial thyroid hormone in neonates is feasible: cord blood and neonatal three-day arterial thyroid hormone index (TSH, TT3, TT4, FT3 and FT4) The regression equation of TSH, TT3, TT4, FT3 and FT4 were Y = 84.215 + 0.067X (P <0.05), Y = 8.765 Y = 1.021 + 1.245X (P <0.05), Y = 1.856 + 0.272X (P <0.05), Y = 8.765 + 0.457X (P <0.05) Thyroid hormone levels in neonatal 3-day arterial blood. Conclusion The use of cord blood instead of traumatic arterial puncture blood analysis of thyroid hormone levels, both for parents accepted, but also early detection and intervention of neonatal hypothyroidism disease.