摘要
目的 调查1989—2014年北京市先天性甲状腺功能减低症（CH）发病特征及影响因素。方法 在北京市新生儿疾病筛查中心信息库中调取1989—2014年新生儿筛查及CH诊治信息。均选用促甲状腺激素（TSH）为筛查参数，先后应用放射免疫分析法（RIA，1989—1995年）、ELISA（1996—2003年）及时间分辨荧光免疫法（DEFIA，2004—2014年）进行筛查检测，不同方法筛查切值参考同时期国际标准（1989—1995年：20 mIU/L，1996—2014年：10 mIU/L）设定；根据原卫生部2010年颁布的《苯丙酮尿症和先天性甲状腺功能减低症诊治技术规范》进行CH诊断。同期活产信息来源于北京市产科质量报表。进行不同筛查方法CH发病率比较，以及不同年份CH发病率趋势分析。为排除筛查方法的影响，选取2004—2014年数据进行影响CH发病的相关因素分析。结果 北京市1989—2014年CH总体发病率为36.7/10万，其中永久性CH（PCH）与暂时性CH（TCH）发病率分别为16.4/10万和15.9/10万；CH年度发病率由1989年的11.2/10万上升至2014年的51.0/10万（χ2=119.02，P〈0.001），其中PCH由5.6/10万升至16.0/10万（χ2=34.38，P〈0.001），TCH由5.6/10万升至13.0/10万（χ2=26.93，P〈0.001），均呈上升趋势；PCH中，甲状腺发育或位置异常占70.44%（255/362），功能缺陷占29.56%（107/362）。2004—2014年，女性CH发病率（51.7/10万）高于男性（37.0/10万），过期产者（334.5/10万）和早产者（77.8/10万）CH发病率高于足月产者（41.4/10万），低出生体重者CH发病率（87.7/10万）高于正常体重者（42.4/10万）和巨大儿者（42.6/10万），P值均〈0.001。结论 1989—2014年北京市CH发病率和PCH、TCH发病率均呈升高趋势；女性、过期产、早产及低出生体重是影响北京市CH发病的重要因素。
Objective To investigate the epidemiologic characteristics and risk factors for congenital hypothyroidism （CH） in Beijing between the years 1989 and 2014.Methods Information on neonatal screening, and diagnoses and treatment of CH from 1989 to 2014 were obtained from the database of the Beijing Neonatal Screening Center. The screening parameter was thyroid-stimulating hormone （thyrotropin; TSH）, which was measured by radioimmunoassay （RIA） from 1989 to 1995, enzyme-linked immunosorbent assay （ELISA） from 1996 to 2003, and time-resolved fluorescence immunoassay （DELFIA？） from 2004 to 2014. The cutoff value of each screening method was set as the international standard for the corresponding years （20 mIU/L from 1989 to 1995 and 10 mIU/L from 1996 to 2014）. CH was diagnosed using ＂The Technical Specification of Diagnosis and Treatment of Phenylketonuria and Congenital Hypothyroidism＂ , published in 2010 by the Ministry of Health of the People＇s Republic of China. Data on live birth infants were obtained from Beijing obstetric quality reports. The incidence of CH using different screening methods was compared, and trends in annual incidence were analyzed. To exclude the influence of different screening methods, data from the years 2004 to 2014 were used to identify the risk factors for CH.Results Between 1989 and 2014, the incidence of CH in Beijing was 36.7 per 100 000 individuals, with permanent CH （PCH） and transient CH （TCH） having incidences of 16.4 per 100 000 and 15.9 per 100 000, respectively. The annual incidence of CH increased from 11.2 per 100 000 in 1989 to 51.0 per 100 000 in 2014 （χ2=119.02, P〈0.001）, with PCH increasing from 5.6 to 16.0 per 100 000 （χ2=34.38, P〈0.001） and TCH increasing from 5.6 to 13.0 per 100 000 （χ2=26.93, P〈0.001）. Among the PCH cases, 70.44% （255/362） were thyroid dysgenesis or ectopic glands, while the other 29.56% （107/362） were dyshormonogenesis. Between 2004 and 2014, the incidence of CH in females （51.7/100 000） was higher than in males （37.0/100 000）, and it was higher in post-term （334.5/100 000） and preterm births （77.8/100 000） than that in term births （41.4/100 000）. It was also higher in the low birth weight （87.7/100 000） than the normal （42.4/100 000） and high birth weight （42.6/100 000） populations.Conclusions Between 1989 and 2014, there was a tendency towards an increase in the overall incidence of CH, and the incidence of both PCH and TCH in Beijing. Female sex, preterm birth, older gestational age, low birth weight, and preterm birth were risk factors affecting the incidence of CH in Beijing.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2016年第8期728-732,共5页
Chinese Journal of Preventive Medicine
