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

نوع مقاله : مقاله مروری

نویسندگان

1 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استاد، گروه بیماری‌های کودکان، دانشکده‌ی پزشکی و مرکز تحقیقات رشد و نمو کودکان، پژوهشکده‌ی پیشگیری اولیه از بیماری‌های غیر واگیر، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 مرکز تحقیقات علوم رفتاری و اجتماعی در سلامت و گروه اپیدمیولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شاهرود، شاهرود، ایران

4 دستیار، مرکز تحقیقات غدد و متابولیسم، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

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 پایگاه‌های علمی PubMed، Google Scholar و Scopus تا تاریخ 30 فروردین سال 1393 انجام گرفت. جهت جستجو محدودیت زمانی در نظر گرفته نشد و جستجو محدود به زبان انگلیسی بود. مقالات نامرتبط پس از مطالعه‌ی عنوان، چکیده و متن کامل مقاله استخراج شد. دو پژوهشگر به صورت مجزا کار تفکیک داده‌ها را انجام دادند و نفر سوم در روند استخراج داده‌ها نظارت داشت. در نهایت، اطلاعات مورد نیاز 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. همچنین، 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.

کلیدواژه‌ها

عنوان مقاله [English]

Thyroid Dysfunction in Very-Low-Birth-Weight Premature Neonates: A Systematic Review of Published Evidence

نویسندگان [English]

  • Arman Ansari 1
  • Mahin Hashemipour 2
  • Mojtaba Keikha 3
  • Reza Najafi 4
1 Student of Medicine, Students Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Professor, Department of Pediatrics, School of Medicine AND Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
3 Center for Health Related Social and Behavioral Sciences Research AND Department of Epidemiology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
4 Resident, Isfahan Endocrine and Metabolic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Congenital hypothyroidism is the most common preventable cause of mental retardation in children and should be diagnosed and treated at the earliest time. The prevalence of congenital hypothyroidism is high in preterm infants with low and very low birth weight.Methods: A systematic literature review was conducted using PubMed, Scopus and Google Scholar databases to 19 April 2014. We did not consider any time limitation; English-language papers were included. Irrelevant studies were set aside after studying their title, abstract, and full text. Two reviewers extracted the data; besides, the third reviewer checked their extracted data. In final, the data extracted from related studies.Findings: Normal serum thyroid-stimulating hormone (TSH) at third to sixth days of birth in low- and very-low-birth-weight preterm infants did not indicate normal thyroid function. In addition, TSH level of more than 10 mIu/l at the second week of the birth did not have a diagnostic value. A TSH level of 10-15 mIu/l, after a normal TSH value, posed the diagnosis of hypothyroidism with delayed TSH rise. Serum levels of free-T4 (FT4) and T4 would be normal at 2 to 8 weeks after the birth.Conclusion: It is recommended to repeat the screening of preterm newborns with low and very low birth weight by measuring TSH and FT4 levels simultaneously at two, six and ten weeks after the birth; the threshold of TSH = 10 mIu/l should be considered to select positive and suspected cases of the disease.

کلیدواژه‌ها [English]

  • Congenital hypothyroidism
  • Premature birth
  • Low birth weight
  • Screening
  • Systematic Review

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 416 - شماره پیاپی 416
بهمن و اسفند 1395
صفحه 1706-1722

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سابقه مقاله

  • تاریخ دریافت: 02 تیر 1393
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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