Objective:To investigate the effects of maternal subclinical hypothyroidism (SCH) on preschoolers′ behavioral problems.Methods:Based on the Ma′ anshan Birth Cohort, pregnant women who had their first antenatal checkup in Maternal and Child Health Center in Ma′ anshan were recruited from May 2013 to September 2014. Data on demographic, obstetric information, and maternal exposure were collected. Women′s fasting venous blood in the first, second, and third trimesters of pregnancy was collected. The levels of thyroid hormones [thyrotropin (TSH), free thyroxine (FT 4)] and thyroid autoantibodies [thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb)] in maternal blood were retrospectively detected by electrochemiluminescence immunoassay. Preschoolers′ behavioral problems were assessed by Achenbach Child Behavior Checklist (CBCL/1.5-5). Poisson regression models were adopted to examine the effect of maternal SCH on preschoolers′ internalizing and externalizing problems and the critical period. Results:In this study, the reference of maternal thyroid indexes was established (between 2.5 th and 97.5 th percentile). The reference of TSH in the first, second, and third trimester of pregnancy was 0.04-4.90 μIU/mL, 0.75-6.08 μIU/mL, and 0.58-5.59 μIU/mL respectively; and the reference of FT 4 was 13.19-23.27 pmol/L, 9.14-15.32 pmol/L, and 9.53-17.45 pmol/L respectively. In the first, second, and third trimester of pregnancy, the prevalence of SCH was found to be 2.0% (25/1 224), 1.6% (19/1 218), and 1.7% (21/1 220), respectively. After adjusting for confounding factors, maternal SCH in the first trimester was associated with the risk of anxiety and depression in preschool children ( OR=3.06, 95% CI 1.05-8.98). Maternal SCH in the second trimester was found to be associated with the risk of overreaction in preschool children ( OR=2.65, 95% CI 1.13-6.21). Conclusions:The establishment of thyroid hormones reference range for pregnant women in Ma′ anshan area is beneficial to the screening, diagnosis, and treatment of thyroid diseases during pregnancy in this area. Maternal SCH during pregnancy is associated with increased risk of behavioral problems in preschool children. In the first trimester, maternal SCH was associated with preschoolers′ anxiety and depression, and in the second trimester, maternal SCH was associated with preschoolers′ emotional reactivity.

ObjectiveTo investigate the risk factors for portopulmonary hypertension （POPH） in liver cirrhosis， and to construct a noninvasive predictive model. MethodsA retrospective analysis was performed for the clinical data of 310 cirrhotic patients with portal hypertension who were hospitalized in The Third Affiliated Hospital of Hebei Medical University from January 2013 to August 2022， and according to whether pulmonary artery systolic pressure was ≥40 mmHg on ultrasound， the patients were divided into POPH group with 31 patients and non-POPH group with 279 patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. A binary Logistic regression analysis was used to determine the independent risk factors for POPH， and a nomogram prediction model was constructed. The Bootstrap resampling method was used for internal validation， and C-index and calibration curve were used to assess the discriminatory ability and consistency of the model. The rms package was used to plot the nomogram. ResultsCompared with the non-POPH group， the POPH group had a significantly younger age， a significantly higher proportion of women or patients with hepatic encephalopathy or Child-Pugh class C disease， and significantly higher levels of direct bilirubin， Model for End-Stage Liver Disease score， albumin-bilirubin （ALBI） score， international normalized ratio， prothrombin time， FIB-4 index， LOK score， and Forns index， as well as significantly lower levels of serum albumin， alanine aminotransferase， gamma-glutamyl transpeptidase， hemoglobin， total cholesterol， and triglycerides （all P<0.05）. The multivariate analysis showed that sex （odds ratio ［OR］=0.172， 95% confidence interval ［CI］： 0.064‍ ‍—‍ ‍0.462， P<0.001）， age （OR=0.944， 95%CI： 0.901‍ ‍—‍ ‍0.989， P=0.016）， ALBI score （OR=3.091， 95%CI： 1.100‍ ‍—‍ ‍8.687， P=0.032）， and hepatic encephalopathy （OR=3.466， 95%CI： 1.331‍ ‍—‍ ‍9.031， P=0.011） were independent risk factors for POPH. A predictive model for POPH in liver cirrhosis was established based on the above independent risk factors， with a C-index of 0.796 （95%CI： 0.701‍ ‍—‍ ‍0.890）， suggesting that the model had good discriminatory ability， and the calibration curve showed that the model had good calibration ability， suggesting that the model had certain predictive efficacy. ConclusionYoung female individuals， elevated ALBI score， and comorbidity with hepatic encephalopathy are independent risk factors for POPH in patients with liver cirrhosis， and the predictive model established based on these factors has a certain clinical application value.