本文選題：先天性甲狀腺功能減低癥 + 流行特征��； 參考：《山西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:了解山西省先天性甲狀腺功能減低癥(Congenital hypothyroidism,CH)的發(fā)病情況及流行病學(xué)特征,分析CH患兒治療效果,為CH患兒的預(yù)防和治療提供科學(xué)的依據(jù)。方法:第一部分:山西省CH流行病學(xué)特征分析回顧性調(diào)查過去2004年10月1日-2014年9月31日年山西省11個地市119個縣區(qū)新生兒CH的篩查情況。篩查的新生兒共計3248791例。新生兒出生72 h后采足跟血,滴在制成的濾紙干血片上,采用酶免疫熒光法分析測定血中促甲狀腺素(thyroid-stimulating hormone,TSH)濃度。TSH切值≥9.05uIU/ml者,電話召回進行電化學(xué)發(fā)光法測定TSH、FT4(free thyroxine)值,確診CH病例填寫《新生兒疾病篩查登記表》并進行治療。登記表內(nèi)容包括出生年月、性別、居住地、確診時間、母孕期的情況、家族史等資料。結(jié)果運用Excel 2003、SPSS 16.0等軟件進行統(tǒng)計。第二部分:山西省CH治療效果分析1.選取2004年10月-2014年9月在山西省新篩中心確診的412例CH患兒(其中2011-2014年CH病例除外長治市、晉城市、大同市、朔州市、運城市),根據(jù)《新生兒篩查規(guī)范(2010版)》,患兒診斷暫時性CH、永久性CH。2.記錄患兒在6月齡、1歲時的身高、智商值、血常規(guī)、血鋅、尿碘、超聲骨強度、骨齡值,分析患兒的體格、智力發(fā)育及微量營養(yǎng)素缺乏情況。3.隨機抽取山西省婦幼保健院兒�？崎T診體檢的6月、1歲健康兒童作為對照組,分析CH患兒治療后的效果。4.針對2010.10.1-2014.9.30確診的231例CH患兒,采用查閱病例及《新生兒疾病篩查登記表》的方式收集相關(guān)因素,按定期隨訪治療分為依從性好與依從性差兩組,非條件logistic回歸分析其影響因素。結(jié)果運用excel2003、spss16.0等軟件進行統(tǒng)計分析。結(jié)果:第一部分:山西省ch流行病學(xué)特征分析1.2004年10月1日2014年9月30日山西省篩查新生兒1323846例。2005年篩查率為5%,2014年上升為92.38%,平均篩查率為40.75%。初篩陽性人數(shù)3193例,召回人數(shù)2669例,召回率83.9%。確診ch人數(shù)577例,檢出率為1/2294。各地市檢出率不等,其中呂梁市最高1/1374,朔州市最低1/3833。2.ch檢出率隨時間波動,以5月、6月檢出率最低,從9月到12月逐漸升高。第二部分:山西省ch治療效果分析1.暫時性ch患兒在6月、1歲時的發(fā)育商與正常組兒童相比,差異無統(tǒng)計學(xué)意義(p㧐0.05);而永久性ch患兒與正常組相比,差異有統(tǒng)計學(xué)意義(p0.05)。2.暫時性ch患兒、永久性ch患兒與正常組兒童在1歲時的骨強度相比,差異無統(tǒng)計學(xué)意義(p㧐0.05)。3.6月ch患兒29.2%(50/171)營養(yǎng)性貧血,79.3%(119/150)鋅缺乏;1歲患兒19.5%(26/133)碘缺乏,23.7%骨強度不足,13.8%(23/168)患兒骨齡異常。4.定期隨訪治療依從性的影響因素:單因素分析顯示,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)、母親文化高(x2=8.27,p=0.02)、甲低患兒(x2=4.20,p=0.04)是定期隨訪治療依從性高的有利因素。多因素logistic逐步回歸分析顯示:血清tsh值(or=17.135)、路途近(or=1.692)、甲低診斷(or=4.028)引入logistic回歸模型具有統(tǒng)計學(xué)意義(p0.05)。結(jié)論:1.山西省CH檢出率1/2294,部分地區(qū)篩查率較低,應(yīng)加強新生兒疾病管理,加大宣傳力度,提高新生兒疾病篩查率,降低出生缺陷發(fā)生率,提高我省出生人口素質(zhì)。2.新生兒疾病篩查是早期診斷、早期治療CH最有效的措施,需對永久性CH患兒高度重視,積極采取措施提高其智能水平。3.針對路途遠、母親文化低、診斷為高TSH血癥患兒積極采取措施加強管理,提高CH患兒定期隨訪治療的依從性,更好的促進CH患兒的生長及智能發(fā)育水平。4.在隨訪治療CH期間,應(yīng)關(guān)注CH患兒微量營養(yǎng)素的監(jiān)測。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R725.8

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