دوره 34، شماره 416: هفته چهارم اسفند ماه 1395:1706-1722

غربالگری هیپوتیروئیدی در نوزادان پره‌ترم با وزن تولد کم و بسیار کم: مرور منظم مقالات و شواهد موجود

آرمان انصاری, مهین هاشمی‌پور, مجتبی کیخا, رضا نجفی

چکیده


مقدمه: هیپوتیروئیدی مادرزادی (Congenital hypothyroidism یا CH) شایع‌ترین علت قابل پیشگیری کم‌کاری ذهنی در کودکان است و باید در سریع‌ترین زمان تشخیص داده شود و برای آن درمان صورت گیرد. شیوع CH در نوزادان پره‌ترم و با وزن تولد کم، بسیار بیشتر است.

روش‌ها: جستجوی مقالات در پايگاه‌هاي علمي PubMed، Google Scholar و Scopus تا تاريخ 30 فروردين سال 1393 انجام گرفت. جهت جستجو محدوديت زماني در نظر گرفته نشد و جستجو محدود به زبان انگليسي بود. مقالات نامرتبط پس از مطالعه‌ی عنوان، چکیده و متن كامل مقاله استخراج شد. دو پژوهشگر به صورت مجزا كار تفکیک داده‌ها را انجام دادند و نفر سوم در روند استخراج داده‌ها نظارت داشت. در نهايت، اطلاعات مورد نياز از مقالات استخراج و گزارش گردید.

یافته‌ها: میزان TSH (Thyroid-stimulating hormone) طبیعی در روزهای سوم تا ششم تولد، دلیل بر عملکرد طبیعی تیروئید نیست. همچنين، TSH بیشتر از mIu/l 10 در هفته‌ی دوم تولد ارزش تشخیصی دارد و TSH بیشتر از mIu/l 15-10 پس از یک TSH نرمال، تشخیص Hypothyroidism with delayed TSH rise را مطرح می‌کند. مقادیر 4FT (4Free T) و Thyroxine (4T) بین هفته‌ی دوم تا هشتم تولد، طبیعی می‌شود.

نتیجه‌گیری: پیشنهاد می‌گردد که غربالگری نوزادان پره‌ترم اعم از دوقلویی یا چند قلویی با وزن کم و بسیار کم در هفته‌های دوم، ششم و دهم پس از تولد از طریق اندازه‌گیری هم‌زمان TSH و 4FT تکرار شود و حد آستانه‌ی تشخیصی TSH (mIu/l 10) یا 4FT و 4T پایین پس از هفته‌ی سوم تا ششم تولد برای انتخاب موارد مشکوک و مثبت بیماری منظور گردد.


واژگان کلیدی


كم‌كاري مادرزادي تيروئيد؛ غربالگري؛ وزن كم زمان تولد؛ نوزاد پره‌ترم؛ مرور منظم

تمام متن:

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مراجع


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