Analysis of thyroxine levels in retinopathy of prematurity in severe preterm infants_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhang Caiyu , Shi Caixiao ,  Sun Huiqing

Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou 450018, China;

Corresponding author：

Sun Huiqing, Email: s_huiqing@sina.com

Keywords：

Retinopathy of prematurity; Thyroid function; Preterm infants

DOI：

10.3760/cma.j.cn511434-20250430-00195

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Objective To observe and analyze thyroxine levels in children with retinopathy of prematurity (ROP) and its effect on severe ROP. Methods A retrospective clinical study. From January 2022 to December 2023, a total of 64 premature infants with severe ROP (ROP group), hospitalized in the Children's Hospital Affiliated to Zhengzhou University and with a gestational age ≤32 weeks, were included. According to a 1:2 ratio, 128 premature infants without ROP, matched for sex and gestational age, were selected as the control group. Thyroid function tests were performed 7 to 14 d after birth. The levels of thyroid-stimulating hormone, triiodothyronine, free triiodothyronine, thyroxine (T4), and free T4 (FT4) were compared and observed between the two groups. The quantitative data between groups were compared by independent samples t-test or Mann-Whitney U test; the count data were compared by χ² test. Logistic regression was used to analyze the correlation between various variables and the occurrence of severe ROP. The predictive efficacy of the differential indicators was assessed by receiver operating characteristic (ROC) curve. Results Compared with the control group, T4 and FT4 levels were significantly lower in children in the ROP group, and the difference was statistically significant (t=2.572, 2.704; P=0.011, 0.008). The results of univariate logistic regression analysis showed that the Apgar scores at 1 and 5 minutes, as well as sepsis, T4, FT4, and bronchopulmonary dysplasia (BPD), were significantly associated with the occurrence of severe ROP (P ＜ 0.05). The results of multivariate logistic regression analysis indicated that FT4 and BPD are independent risk factors for the occurrence of severe ROP (P ＜ 0.05). The ROC curve analysis showed a sensitivity of 80.9% and a specificity of 43.3% for T4. The abnormal threshold was 98.4 nmol/L. Conclusions The T4 and FT4 level of children with severe ROP are lower than that of children without ROP in the early postnatal period. The T4 and FT4 level in the early postnatal period may have a certain correlation with the occurrence of severe ROP.

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1. Sapieha P, Joyal JS, Rivera JC, et al. Retinopathy of prematurity: understanding ischemic retinal vasculopathies at an extreme of life[J]. J Clin Invest, 2010, 120(9): 3022-3032. DOI: 10.1172/jci42142.
2. García-Aldea Á, Guillén-Yunta M, Valcárcel-Hernández V, et al. Insights on the role of thyroid hormone transport in neurosensory organs and implication for the Allan-Herndon-Dudley syndrome[J/OL]. Eur Thyroid J, 2024, 13(2): e230241[2024-03-19]. https://pubmed.ncbi.nlm.nih.gov/38417253/. DOI: 10.1530/ETJ-23-0241.
3. Vancamp P, Bourgeois NMA, Houbrechts AM, et al. Knockdown of the thyroid hormone transporter MCT8 in chicken retinal precursor cells hampers early retinal development and results in a shift towards more UV/blue cones at the expense of green/red cones[J]. Exp Eye Res, 2019, 178: 135-147. DOI: 10.1016/j.exer.2018.09.018.
4. Nicolini G, Casini G, Posarelli C, et al. Thyroid hormone signaling in retinal development and function: implications for diabetic retinopathy and age-related macular degeneration[J/OL]. Int J Mol Sci, 2024, 25(13): 7364[2024-07-04]. https://pubmed.ncbi.nlm.nih.gov/39000471/. DOI: 10.3390/ijms25137364.
5. Yoon SA, Chang YS, Yang M, et al. Effect of levothyroxine supplementation in extremely low birth weight infants with transient hypothyroxinemia of prematurity[J/OL]. Sci Rep, 2022, 12(1): 9717[2022-06-11]. https://pubmed.ncbi.nlm.nih.gov/35690687/. DOI: 10.1038/s41598-022-13927-2.
6. 中国医师协会新生儿科医师分会. 早产儿治疗用氧和视网膜病变防治指南(修订版)[J]. 中华实用儿科临床杂志, 2013, 28(23): 1835-1836. DOI: 10.3760/cma.j.issn.2095-428X.2013.23.023.Neonatologist Society, Chinese Medical Doctor Association. Guidelines for oxygen therapy and retinopathy of prematurity prevention and treatment (revised edition)[J]. Chin J Pract Pediatr, 2013, 28(23): 1835-1836. DOI: 10.3760/cma.j.issn.2095-428X.2013.23.023.
7. 中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.Ophthalmology Group, Ophthalmology Society of Chinese Medical Association. Chinese screening guidelines for retinopathy of prematurity(2014)[J]. Chin J Ophthalmol, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.
8. Smith LE. Pathogenesis of retinopathy of prematurity[J]. Growth Horm IGF Res, 2004, 14(Suppl A): S140-144. DOI: 10.1016/j.ghir.2004.03.030.
9. Vannay A, Dunai G, Bányász I, et al. Association of genetic polymorphisms of vascular endothelial growth factor and risk for proliferative retinopathy of prematurity[J]. Pediatr Res, 2005, 57(3): 396-398. DOI: 10.1203/01.Pdr.0000153867.80238.E0.
10. Stevens A, Soden J, Brenchley PE, et al. Haplotype analysis of the polymorphic human vascular endothelial growth factor gene promoter[J]. Cancer Res, 2003, 63(4): 812-816.
11. Can E, Bülbül A, Uslu S, et al. Early aggressive parenteral nutrition induced high insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) levels can prevent risk of retinopathy of prematurity[J]. Iran J Pediatr, 2013, 23(4): 403-410.
12. Hellstrom A, Perruzzi C, Ju M, et al. Low IGF-I suppresses VEGF-survival signaling in retinal endothelial cells: direct correlation with clinical retinopathy of prematurity[J]. Proc Natl Acad Sci USA, 2001, 98(10): 5804-5808. DOI: 10.1073/pnas.101113998.
13. 马小龙, 马金海, 邓林利. 胰岛素样生长因子-1在儿童生长激素缺乏症诊断中的应用价值[J]. 宁夏医学杂志, 2023, 45(7): 611-613. DOI: 10.13621/j.1001-5949.2023.07.0611.Ma XL, Ma JH, Deng LL. Application value of insulin-like growth factor-1 in the diagnosis of growth hormone deficiency in children[J]. Ningxia Medical Journal, 2023, 45(7): 611-613. DOI: 10.13621/j.1001-5949.2023.07.0611.
14. Liu X, Zheng N, Shi YN, et al. Thyroid hormone induced angiogenesis through the integrin αvβ3/protein kinase D/histone deacetylase 5 signaling pathway[J]. J Mol Endocrinol, 2014, 52(3): 245-254. DOI: 10.1530/jme-13-0252.
15. Berkowitz BA, Luan H, Roberts RL. Effect of methylimidazole-induced hypothyroidism in a model of low retinal neovascular incidence[J]. Invest Ophthalmol Vis Sci, 2004, 45(3): 919-921. DOI: 10.1167/iovs.03-0914.
16. Sevilla-Romero E, Muñoz A, Pinazo-Durán MD. Low thyroid hormone levels impair the perinatal development of the rat retina[J]. Ophthalmic Res, 2002, 34(4): 181-191. DOI: 10.1159/000063885.
17. Rao NA, Wu GS. Oxygen free radicals and retinopathy of prematurity[J/OL]. Br J Ophthalmol, 1996, 80(5): 387[1996-05-01]. https://pubmed.ncbi.nlm.nih.gov/8695553/. DOI: 10.1136/bjo.80.5.387.
18. Banjac L, Banjac G, Kotur-Stevuljević J, et al. Pro-oxidants and antioxidants in retinopathy of prematurity[J]. Acta Clin Croat, 2018, 57(3): 458-463. DOI: 10.20471/acc.2018.57.03.08.
19. Amato R, Catalani E, Dal Monte M, et al. Morpho-functional analysis of the early changes induced in retinal ganglion cells by the onset of diabetic retinopathy: the effects of a neuroprotective strategy[J/OL]. Pharmacol Res, 2022, 185: 106516[2022-10-19]. https://pubmed.ncbi.nlm.nih.gov/36272637/. DOI: 10.1016/j.phrs.2022.106516.
20. Mutapcic L, Wren SM, Leske DA, et al. The effect of L-thyroxine supplementation on retinal vascular development in neonatal rats[J]. Curr Eye Res, 2005, 30(12): 1035-1040. DOI: 10.1080/02713680500320711.

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Latest ArticlesAnalysis of thyroxine levels in retinopathy of prematurity in severe preterm infants

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