摘要
目的分析不同促甲状腺激素(TSH)切值对广西新生儿先天性甲状腺功能减低症(CH)筛查的影响。方法收集2017年5月至2018年4月广西壮族自治区妇幼保健院遗传代谢中心利用全自动荧光分析仪法(GSP)对83608例新生儿检测的TSH结果,分别用百分位数法和受试者工作特征(ROC)曲线法计算切值,同时与假设切值9.00或10.00mU/L进行比较,分析4种不同TSH切值对CH筛查的影响。结果应用GSP,83608例新生儿TSH检测结果呈现正偏态分布,TSH切值百分位数法[第99百分位数(P99)]为7.96mU/L,可疑阳性836例,确诊CH43例(漏诊6例)、高TSH血症65例(漏诊21例);TSH切值ROC曲线法为6.45mU/L,可疑阳性1480例,确诊CH49例、高TSH血症86例,均无漏诊。当切值为9.00或10.00mU/L时,可疑阳性分别为478、305例,确诊CH分别为37、35例(漏诊分别为12、14例),确诊高TSH血症分别为46、33例(漏诊分别为40、53例)。CH发病率ROC曲线法与百分位数法及假设切值9.00、10.00mU/L时比较,差异有统计学意义(P均<0.05)。结论利用GSP和ROC曲线法成功确立了广西新生儿CH筛查TSH切值,采用该切值既能保证筛查的准确性,还能避免发生漏诊,降低出生缺陷。
Objective To analyze the effects of different thyroid stimulating hormone (TSH) cut-off values on the screening of congenital hypothyroidism (CH) in newborns in Guangxi. Methods The TSH results of 83 608 newborns tested by Genetic Screening Processor (GSP) from the Genetic Metabolism Center of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from May 2017 to April 2018 were collected. Using the percentile method and the receiver operating characteristic (ROC) curve method, the TSH cut-off values were calculated and compared with the assumed cut-off values 9.00 or 10.00 mU/L, to analyze the effects of four different TSH cut-off values on CH screening. Results Using GSP, the TSH results of 83 608 newborns showed a positive skewed distribution, TSH cut-off value of the percentile method (P99) was 7.96 mU/L, 836 cases were suspicious, 43 cases were diagnosed with CH (6 cases were missed diagnosis), and 65 cases were high TSH (21 cases were missed diagnosis);TSH cut-off value of the ROC curve method was 6.45 mU/L, 1 480 case were suspicious, 49 cases were diagnosed with CH, and 86 cases were high TSH, both were no missed diagnosis;when TSH cut-off values were 9.00 or 10.00 mU/L, the suspicious were 478 and 305 cases, respectively, and the confirmed CH were 37 and 35 cases (missed diagnosis were 12 and 14 cases, respectively), high TSH were 46 and 33 cases (missed diagnosis were 40 and 53 cases, respectively). The CH incidence of the ROC curve method was compared with the percentile method and using the cut-off values 9.00 and 10.00 mU/L, the differences were statistically significant (P < 0.05). Conclusions The GSP and ROC curve method were used to successfully establish the TSH cut-off value on the screening of CH in newborns in Guangxi. The cut-off value can not only ensure the accuracy of screening, but also avoid missed diagnosis and reduce birth defects.
作者
林彩娟
范歆
玉晋武
耿国兴
黄小桃
韦芳潞
Lin Caijuan;Fan Xin;Yu Jinwu;Geng Guoxing;Huang Xiaotao;Wei Fanglu(Genetic Metabolism Center,the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2019年第9期706-709,共4页
Chinese Journal of Endemiology
基金
国家自然科学基金(81260126).
