新生儿促甲状腺激素-监测碘缺乏严重程度的指示。什么水平被认为是“截止点”?]

Q4 Medicine
L A Suplotova, O B Makarova, A Troshina
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引用次数: 0

摘要

背景:监测碘缺乏症预防项目的有效性是碘消除过程中的一个重要组成部分。自1994年以来,新生儿促甲状腺激素(TSH)一直被用作碘缺乏严重程度的标准,然而,新生儿TSH水平的“分界点”问题在最近的文献中被广泛讨论。目的:从监测碘缺乏的角度评价5 mIU/l以上新生儿甲状腺功能亢进的判定标准,并建立碘状态充足的健康孕妇模型的“截断点”。材料与方法:对秋明市孕妇进行前瞻性研究,根据尿中碘的排泄水平分为观察组——主组(整个妊娠期碘含量充足)和对照组(碘含量低于150 μg/l)。对参与研究的妇女的儿童进行先天性甲状腺功能减退症新生儿筛查的结果进行了评估。观察组新生儿TSH高于5mIU/l的频率。进行roc分析,并建立新生儿TSH水平的“截断点”作为碘缺乏的指标。结果:秋明市孕妇尿碘浓度中位数为159.05 μg/l,甲状腺肿发生率为0.38%,新生儿甲状腺功能亢进5 mIU/l以上发生率为2.88%,表明孕妇尿碘摄入充足。主组妇女新生儿TSH高于5 mIU/l的发生率为1.47%,对照组为- 9.3% (p = 0.076)。ROC分析显示,截断点新生儿TSH阈值为2.77 mIU/l,与约登指数的最高值相对应。预测尿碘浓度大于150 μg/l,而nTSH值低于此值。结论:对新生儿先天性甲状腺功能减退症筛查数据库进行分析,可以有效、快速、低成本地每年评估人群的碘状况。在我们的工作中,在碘摄入充足的健康孕妇模型中,建立的新生儿TSH“截断点”为2.77 mIU/l,在妊娠期间不同碘水平的妇女中,新生儿甲状腺功能亢进症的发生率在5 mIU/l以上没有统计学上的显著差异,这表明有必要修改现有的5 mIU/l阈值,并可能是在不同碘供应地区进行大规模研究的动机。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

[Neonatal thyrotropin - indicatior of monitoring of iodine deficiency severity. What's level is considered a «cutoff point»?]

[Neonatal thyrotropin - indicatior of monitoring of iodine deficiency severity. What's level is considered a «cutoff point»?]

[Neonatal thyrotropin - indicatior of monitoring of iodine deficiency severity. What's level is considered a «cutoff point»?]

[Neonatal thyrotropin - indicatior of monitoring of iodine deficiency severity. What's level is considered a «cutoff point»?]

Background: The issues of monitoring the effectiveness of iodine deficiency prevention programs are an important component in the process of iodine elimination. Neonatal thyrotropin (TSH) has been used as a criterion for the severity of iodine deficiency since 1994, however, the question of the "cut-off point" of the neonatal TSH level has been widely discussed in the recent literature.

Aim: Evaluate the criterion for neonatal hyperthyroidism above 5 mIU/l from the perspective of monitoring iodine deficiency and establish a «cut-off point» on the model of healthy pregnant women with adequate iodine status.

Materials and methods: A prospective study was conducted in a population of pregnant women in the city of Tyumen, with the formation of observation groups according to the level of iodine excretion in the urine - the main group (with adequate iodine status throughout the entire gestation period) and the comparison group (women with iodine levels less than 150 μg/l). The results of neonatal screening for congenital hypothyroidism in children of women participating in the study were evaluated. The frequency of neonatal TSH above 5mIU/l was assessed in the observation groups. ROC-analysis was performed and a «cut-off point» of the level of neonatal TSH was established as an indicator of iodine deficiency.

Results: The median urinary iodine concentration in the population of pregnant women in Tyumen was 159.05 μg/l, the incidence of goiter was 0.38%, the incidence of neonatal hyperthyroidism above 5 mIU/l was 2.88%, which characterizes adequate iodine intake in the pregnant population women. The frequency of neonatal TSH above 5 mIU/l in newborns from women from the main group was 1.47%, and in the comparison group - 9.3% (p = 0.076). ROC analysis revealed a threshold value of neonatal TSH of 2.77 mIU/l at the cut-off point, which corresponded to the highest value of the Youden index. Urinary iodine concentrations greater than 150 μg/l were predicted for nTSH values below this value.

Conclusion: Analysis of databases of neonatal screening for congenital hypothyroidism makes it possible to effectively, quickly and at minimal cost annually assess the iodine status in the population. The established «cut-off point» of neonatal TSH in the model of healthy pregnant women with adequate iodine intake in our work is 2.77 mIU/l, the absence of statistically significant differences in the incidence of neonatal hyperthyroidism above 5 mIU/l from women with different iodine status during pregnancy indicate the need to revise the existing threshold of 5 mIU/l and may be an incentive to conduct large-scale studies in regions with different iodine supply.

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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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