山西省先天性甲状腺功能减低症流行病学特征及治疗效果分析

发布时间：2018-06-19 21:29

本文选题：先天性甲状腺功能减低症 + 流行特征　；参考：《山西医科大学》2016年硕士论文

【摘要】：目的:了解山西省先天性甲状腺功能减低症(Congenital hypothyroidism,CH)的发病情况及流行病学特征,分析CH患儿治疗效果,为CH患儿的预防和治疗提供科学的依据。方法:第一部分:山西省CH流行病学特征分析回顾性调查过去2004年10月1日-2014年9月31日年山西省11个地市119个县区新生儿CH的筛查情况。筛查的新生儿共计3248791例。新生儿出生72 h后采足跟血,滴在制成的滤纸干血片上,采用酶免疫荧光法分析测定血中促甲状腺素(thyroid-stimulating hormone,TSH)浓度。TSH切值≥9.05uIU/ml者,电话召回进行电化学发光法测定TSH、FT4(free thyroxine)值,确诊CH病例填写《新生儿疾病筛查登记表》并进行治疗。登记表内容包括出生年月、性别、居住地、确诊时间、母孕期的情况、家族史等资料。结果运用Excel 2003、SPSS 16.0等软件进行统计。第二部分:山西省CH治疗效果分析1.选取2004年10月-2014年9月在山西省新筛中心确诊的412例CH患儿(其中2011-2014年CH病例除外长治市、晋城市、大同市、朔州市、运城市),根据《新生儿筛查规范(2010版)》,患儿诊断暂时性CH、永久性CH。2.记录患儿在6月龄、1岁时的身高、智商值、血常规、血锌、尿碘、超声骨强度、骨龄值,分析患儿的体格、智力发育及微量营养素缺乏情况。3.随机抽取山西省妇幼保健院儿保科门诊体检的6月、1岁健康儿童作为对照组,分析CH患儿治疗后的效果。4.针对2010.10.1-2014.9.30确诊的231例CH患儿,采用查阅病例及《新生儿疾病筛查登记表》的方式收集相关因素,按定期随访治疗分为依从性好与依从性差两组,非条件logistic回归分析其影响因素。结果运用excel2003、spss16.0等软件进行统计分析。结果:第一部分:山西省ch流行病学特征分析1.2004年10月1日2014年9月30日山西省筛查新生儿1323846例。2005年筛查率为5%,2014年上升为92.38%,平均筛查率为40.75%。初筛阳性人数3193例,召回人数2669例,召回率83.9%。确诊ch人数577例,检出率为1/2294。各地市检出率不等,其中吕梁市最高1/1374,朔州市最低1/3833。2.ch检出率随时间波动,以5月、6月检出率最低,从9月到12月逐渐升高。第二部分:山西省ch治疗效果分析1.暂时性ch患儿在6月、1岁时的发育商与正常组儿童相比,差异无统计学意义(p㧐0.05);而永久性ch患儿与正常组相比,差异有统计学意义(p0.05)。2.暂时性ch患儿、永久性ch患儿与正常组儿童在1岁时的骨强度相比,差异无统计学意义(p㧐0.05)。3.6月ch患儿29.2%(50/171)营养性贫血,79.3%(119/150)锌缺乏;1岁患儿19.5%(26/133)碘缺乏,23.7%骨强度不足,13.8%(23/168)患儿骨龄异常。4.定期随访治疗依从性的影响因素:单因素分析显示,血清tsh值正常(x2=59.87,p=0.000)、血清ft4值正常(x2=6.47,p=0.01)、路途近(x2=14.40,p=0.00)、母亲文化高(x2=8.27,p=0.02)、甲低患儿(x2=4.20,p=0.04)是定期随访治疗依从性高的有利因素。多因素logistic逐步回归分析显示:血清tsh值(or=17.135)、路途近(or=1.692)、甲低诊断(or=4.028)引入logistic回归模型具有统计学意义(p0.05)。结论:1.山西省CH检出率1/2294,部分地区筛查率较低,应加强新生儿疾病管理,加大宣传力度,提高新生儿疾病筛查率,降低出生缺陷发生率,提高我省出生人口素质。2.新生儿疾病筛查是早期诊断、早期治疗CH最有效的措施,需对永久性CH患儿高度重视,积极采取措施提高其智能水平。3.针对路途远、母亲文化低、诊断为高TSH血症患儿积极采取措施加强管理,提高CH患儿定期随访治疗的依从性,更好的促进CH患儿的生长及智能发育水平。4.在随访治疗CH期间,应关注CH患儿微量营养素的监测。
[Abstract]:Objective: to understand the incidence and epidemiological characteristics of congenital hypothyroidism (Congenital hypothyroidism, CH) in Shanxi Province, and to analyze the therapeutic effect of CH children in order to provide scientific basis for the prevention and treatment of children with CH. Method: the first part: a retrospective survey of the epidemiological characteristics of CH in the past October 1, 2004 -2014 A total of 3248791 newborns were screened in 119 counties of 11 prefectures and cities in Shanxi Province in September 31st. A total of 3248791 newborns were screened. After the birth of the newborn 72 h, the heel was collected on the dried blood slices of the filter paper. The concentration of thyroid-stimulating hormone (TSH) in the blood was measured by enzyme immunoassay, and the concentration of.TSH was more than 9.05uIU/ml. The value of TSH, FT4 (free thyroxine) was measured by electrochemiluminescence (electrochemiluminescence), and the diagnosis of CH cases was completed < neonatal disease screening Registration Form > and treated. The contents of the registration form included birth year, sex, residence, diagnosis time, maternal pregnancy, family history and so on. Results the results of Excel 2003, SPSS 16 and other software were used for statistics. The second part: analysis of the therapeutic effect of CH in Shanxi province 1. select 412 cases of CH diagnosed in Shanxi province's new screening center in September October 2004 (excluding Changzhi, Jincheng, Datong, Shuozhou, Yuncheng) for 2011-2014 years, according to the standard of neonatal screening (2010 Edition), children are diagnosed temporary CH, permanent CH.2. records children in 6 Height, IQ value, blood routine, blood zinc, urine iodine, ultrasonic bone strength, bone age value at the age of 1 years, analysis of the physique, intelligence development and micronutrient deficiency of the children.3. randomly selected in the children's health care department of Shanxi maternal and child health care hospital in June, 1 years old healthy children as the control group, analysis of the effect of CH children after treatment.4. aimed at 2010.10.1- 231 cases of CH diagnosed by 2014.9.30 were collected by consulting cases and "neonatal disease screening and registration form" to collect related factors. According to regular follow-up treatment, two groups were divided into good compliance and poor compliance, and the unconditional logistic regression analysis was used to analyze the factors. Results: the results were analyzed by Excel2003, SPSS16.0 and other software. Results: the first part: Analysis of the epidemiological characteristics of Ch in Shanxi province in October 1st in September 30, 2014 1.2004 years in September 30, 2014 in Shanxi Province, 1323846 cases of screening newborn screening rate was 5%, in 2014, the increase was 92.38%, the average screening rate was 3193 cases of 40.75%. screening positive, the number of recalls was 2669 cases, the recall rate was 577 cases of CH people, the detection rate was different from 1/2294. in different cities. Among them, the highest 1/1374 in Lvliang, the lowest 1/3833.2.ch detection rate in Shuozhou fluctuates with time, the lowest detection rate in May, the lowest in June, from September to December. The second part: analysis of the effect of CH treatment in Shanxi province 1. temporary ch children in June, at 1 years of age, the difference is not statistically significant (P? 0.05) compared with the normal group children (P? 0.05); and permanent ch suffering. Compared with the normal group, the difference was statistically significant (P0.05).2. temporary ch children. There was no significant difference in bone strength between children of permanent CH and normal children at the age of 1 (P? 0.05).3.6 month ch children 29.2% (50/171) nutritional anemia, 79.3% (119/150) zinc deficiency; 1 year old children 19.5% (26/133) iodine deficiency, 23.7% bone strength deficiency, 13.8% (2) 3/168) the influence factors of regular follow-up treatment compliance of children with bone age abnormal.4.: single factor analysis showed that serum TSH was normal (x2=59.87, p=0.000), serum FT4 was normal (x2=6.47, p=0.01), the road was near (x2=14.40, p=0.00), mother culture was high (x2=8.27, p=0.02), and hypothyroidism was a favorable factor for the high compliance of regular follow-up treatment. Multi factor logistic stepwise regression analysis showed that serum TSH value (or=17.135), road near (or=1.692), and hypothyroidism (or=4.028) introduced logistic regression model had statistical significance (P0.05). Conclusion: 1. Shanxi province CH detection rate 1/2294, partial region screening rate is low, should strengthen the neonatal disease management, increase publicity efforts to improve neonatal disease. Screening rate, reducing the incidence of birth defects, raising the quality of birth population in our province.2. newborn disease screening is early diagnosis, the most effective measures for early treatment of CH, need to attach great importance to children with permanent CH, actively take measures to improve their intelligence level.3. for the way far, mother culture is low, diagnosis of high TSH children actively take measures plus measures plus Strong management, improve the compliance of regular follow-up treatment for children with CH, better promote the growth and intelligent development level of children with CH,.4. should pay attention to the monitoring of micronutrients in children with CH during the follow-up treatment of CH.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.8

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