| Objective:To provide a scientific basis for the prevention and treatment of congenital hypothyroidism by analyzing the epidemiological characteristics and the therapeutic effects of CH in Shanxi province.Methods:Section I: Analysis on epidemiological characteristics of CH in Shanxi provinceRetrospective survey was used to screen CH newborn from 3248791 cases of live births in Shanxi province(11 cities and 119 counties) over a decade. In detail, after 72 hours, the heel blood of newborns was collected and dropped on the filter paper. Thyroidstimulating hormone(TSH) in blood was checked by enzyme linked immunofluorescence.TSH and FT4(free thyroxine 4) must be detected by the electrochemiluminescence to diagnose the CH when the concentration of TSH was more than 9.05 u IU/ml. The registration form of the newborn disease screening would be filled, and the message includes the date of birth, gender, residence, time of diagnosis, condition during pregnancy,family history and so on. All Data were analyzed by the software of Excel 2003 and SPSS16.0.Section II: The therapeutic effects of CH in Shanxi province412 cases of CH were selected from October 2004- September 2014 in Shanxi newborn screening center(except for the cases of Changzhi, Jincheng, Datong, Shuozhou,Yuncheng from 2011-2014). The data(included the height, IQ, routine blood, blood zinc,bone strength and bone age) of 6 months and 1 year old children were recorded. In addition,the physical and mental development and the deficiencies of micronutrient were analyzed.The temporary CH or permanent CH children were diagnosed according to the screening standards of newborn(2010 edition). The intelligence and bone strength childrenwere detected. The healthy children of 6 months and 1 year old were selected randomly as control group in child healthcare department of Shanxi maternal and child health hospital.Furthermore, 231 cases of CH children, who were diagnosed at 2010.10.1-2014.9.30, were divided into the good compliance group and poor compliance group, according to the regular follow-up treatment. The relevant factors were collected by checking up the case and registration of newborn. The X2 test was used for the single factor analysis and the unconditioned logistic regression was used for the multi-factor analysis. The results were analyzed by the software of Excel 2003 and SPSS 16.0.Results:Section I: Analysis on epidemiological characteristics of CH in Shanxi1. 132384 newborn was screened in Shanxi Province, from 1/10/2004-30/09/2014.The rate of screening was 5% in 2005, and 92.38% in 2014. The average screening rate was 40.75%. 3193 was screened at first screen, and 2669 cases were recalled. The rate of recall was 83.9%. 577 cases were diagnosed as CH. The relevance ratio was 1/2294. In addition, the incidence was different in different cities. The highest incidence(1/1374)was in Lvliang, and the lowest(1/3833) was in Shuozhou.2. The relevance ratio of CH fluctuated with time. The lowest was in May and June,and it increased gradually from September to December.Section II: The therapeutic effects of CH in Shanxi province1. No significant difference was observed in the developmental quotient between the children of temporary CH and the normal group at the age of 6 months and 1 year old(P > 0.05). However, compared with the normal group, the difference of permanent CH was significant(P < 0.05).2. Compared with the normal group, the results of bone strength showed no significant difference in the groups of temporary CH and permanent CH(P > 0.05).3. In the CH children aged 6 months, 29.2%(50/171) were nutritional anemia, and79.3%(119/150) were zinc deficiency. In addition, in the CH children aged one year,19.5%(26/133) were iodine deficiency, 23.7%( 31/131) were the deficiency of bone density, and 13.8%(23/167) were abnormal in bone age.4. Influencing factors of compliance of regular follow-up treatment: The results of single factor analysis showed that the normal levels of TSH( X2=59.87, P=0.000), the normal level of FT4 in serum( X2=6.47, P=0.01), short distance(X2=14.40, P=0.00),higher educated of mother(X2=8.27, P=0.02), and CH children(X2=4.20,P=0.04) made contribution to the compliance of regular follow-up treatment. The results of logistic analysis showed that the normal serum TSH(OR=17.135), the short distance(OR=1.692)and diagnosis of CH(OR=4.028) were introduced into the model of logistic regression(P<0.05).Conclusion:1. The relevance ratio of CH in Shanxi was 1/2294. The rate of screening was low in some areas. Therefore, the management and the publicity of neonatal disease should be strengthened to increase the rate of neonatal screening and reduce the incidence of birth defects.2. Neonatal screening is the most effective measures for the early diagnosis and early treatment of CH. Besides, the permanent CH should be paid more attention, and the active measures should be taken to improve the intelligence level.3. It is essential to take measures actively and reinforce the management of children with long distance, low-educated mother, and the diagnosis of TSH disease. Moreover,enhancing the compliance of regular treatment is the key to improve the growth and development of CH children.4. More attention should be given on the monitoring of micro-nutrients in CH. |
PDF Full Text Request