摘要
目的分析不同促甲状腺激素(TSH)切值对新生儿先天性甲状腺功能减退症(甲减)筛查的意义。方法抽取郑州市第一人民医院2017年4月至2020年4月出生的活产新生儿1 650例,采血检测TSH。检查结果参与卫生部临床检验中心干血片TSH室间质量评价,结果是是成绩合格。分析新生儿血样TSH水平分布情况,观察新生儿TSH水平统计学。参考WHO制定的先天性甲状腺机能减退症(CHT)诊断标准判定CHT,并分析CHT水平。最后分析活体新生儿TSH不同切值的敏感度及特异度。结果 1 650例中0.00~1.00 mU/L 362例(21.94%)、1.00~2.00 mU/L 495例(30.00%)、2.00~3.00 mU/L 401例(24.30%)、3.00~4.00 mU/L 231例(14.00%)、4.00~5.00 mU/L 30例(1.82%)、5.00~6.00 mU/L 28例(1.70%)、6.00~7.00 mU/L 23例(1.39%)、7.00~8.00 mU/L 20例(1.21%)、8.00~9.00 mU/L 14例(0.84%)、9.00~10.00 mU/L 10例(0.61%)、10.00~11.00 mU/L 9例(0.55%),>11.00 mU/L7例(0.42%)。1 650例中1624例为正常新生儿,TSH水平均值3.24 mU/L,中位数2.68 mU/L,最小值0.04 mU/L,最大值30.81mU/L ,90%分位数值5.93 mU/L,95%分位数值7.41 mU/L,99%分位数值10.75 mU/L。1 650例中26例为CHT,TSH水平分布情况为9.00~10.00 mU/L 1例( 3.85%)、10.00~30.00 mU/L 5例(19.23%)、30.00~40.00 mU/L 4例(15.38%)、40.00~50.00 mU/L 2例(7.69%)、50.00~60.00 mU/L1例(3.85%)、60.00~70.00 mU/L 1例(3.85%)、70.00~80.00 mU/L 2例(7.69%)、80.00~90.00 mU/L 1例(3.85%)、90.00~100.00 mU/L 2例(7.69%)、>100.00 mU/L 7例(26.92%)。TSH水平9.00 mU/L敏感度、1-特异性、敏感度+特异度最高,其次是10.00 mU/L、11.00 mU/L、12.00 mU/L、13.00 mU/L、14.00 mU/L、15.00 mU/L。结论 9.00 mU/L作为TSH切值能获得较好的筛查结果,建议临床应用。
Objective To investigate the screening sense of different thyroid stimulating hormone(TSH)cut-off points for newborns with congenital hypothyroidism(CHT).Methods A total of 1650 newborns underwent TSH examination in the First People’s Hospital of Zhengzhou from April 2017 to April 2020 were enrolled,and the distribution of TSH level in blood samples of neonates was analyzed.The diagnostic criteria for CHT were referred to WHO,then the sensitivity and specificity of different cut-off values of TSH for CHT were analyzed.Results The TSH levels of 1650 children were distributed as 0.00-1.00 mU/L 362 cases(21.94%),1.00-2.00 mU/L 495 cases(30.00%),2.00-3.00 mU/L 401 cases(24.30%),3.00-4.00 mU/L 231 cases(14.00%),4.00-5.00 mU/L30 cases(1.82%),5.00-6.00 mU/L28 cases(1.70%),6.00-7.00 mU/L 23 cases(1.39%),7.00-8.00 mU/L 20 cases(1.21%),8.00-9.00 mU/L 14 cases(0.84%),9.00-10.00 mU/L 10 cases(0.61%),10.00-11.00 mU/L 9 cases(0.55%),>11.00 mU/L 7 cases(0.42%).Of the 1650 cases,1624 were normal newborns,with a mean TSH level of 3.24 mU/L,median TSH level of 2.68 mU/L,minimum TSH level of 0.04 mU/L,maximum TSH level of 30.81 mU/L,90%score of 5.93 mU/L,95%score of 7.41 mU/L,and 99%score of 10.75 mU/L.Among the 1650 cases,26 cases were CHT,and TSH level distribution was 9.00-10.00 mU/L 1 case(3.85%),10.00-30.00 mU/L 5 cases(19.23%),30.00-40.00 mU/L 4 cases(15.38%),40.00-50.00 mU/L 2 cases(7.69%),50.00-60.00 mU/L1 cases(3.85%),60.00-70.00 mU/L 1 cases(3.85%),70.00-80.00mU/L 2 cases(7.69%),80-90 mU/L1cases(3.85%),90-100 mU/L 2 cases(7.69%),>100 mU/L 7 cases(26.92%).The sensitivity,1-specificity and sensitivity+specificity of 9.00 mU/L were the highest,followed by 10.00 mU/L,11.00 mU/L,12.00 mU/L,13.00 mU/L,14.00 mU/L and 15.00 mU/L.Conclusions 9.00 mU/L as TSH cut-off value can get better screening results,which is recommended.
作者
王旭昕
杨冰
Wang Xuxin;Yang Bing(Department of Laboratory Medicine,the First People’s Hospital of Zhengzhou,Zhengzhou 450000,China;Department of Laboratory,Henan Children's Hospital,Zhengzhou 450000,China)
出处
《中国实用医刊》
2020年第18期36-39,共4页
Chinese Journal of Practical Medicine
