先天性甲状腺功能低下症患儿的病因分析及左甲状腺素钠治疗后预后研究

Etiological analysis of children with congenital hypothyroidism and study of prognosis after treatment with levothyroxine sodium

目的分析先天性甲状腺功能低下症(CH)的病因,评价左甲状腺素钠(L-T4)治疗后的预后。方法选择我院2013年6月-2017年6月126例CH患儿作为研究对象,确诊后立即给予L-T4治疗,24个月后均行实验室血清甲状腺功能相关指标检查,并结合超声及放射性核素99mTcO4静态显像法明确病因,比较不同病因患儿血清甲状腺素水平及治疗前、治疗24个月后血清甲状腺激素水平变化。结果126例患儿中121例完成24个月的治疗和随访,停止用药1月后测定甲状腺功能相关指标并结合骨龄发育检查、甲状腺扫描结果综合诊断,其中73例永久性CH病因构成分别为甲状腺基本正常15.07%,摄锝功能低下19.18%、甲状腺异位53.42%、甲状腺缺如5.48%和甲状腺发育不良6.85%,48例暂时性CH患儿100%甲状腺基本正常,暂时性和永久性CH患儿病因构成差异有统计学意义(P<0.05)。永久性CH患儿TSH水平高于暂时性CH患儿,FT4水平低于暂时性CH患儿,差异有统计学意义(P<0.05)。两组患儿FT3水平差异无统计学意义(P>0.05)。永久性CH患儿中甲状腺缺如、甲状腺异位、甲状腺发育不良、摄锝功能低下患儿TSH水平高于甲状腺基本正常患儿,FT4水平低于甲状腺基本正常患儿,差异有统计学意义(P<0.05)。暂时性CH骨龄正常率为72.92%,明显高于永久性CH的27.40%,差异有统计学意义(P<0.05)。甲状腺缺如、甲状腺异位患儿TSH水平高于甲状腺发育不良、摄锝功能低下患儿,差异有统计学意义(P<0.05)。治疗24个月后CH患儿TSH水平低于治疗前,FT4水平高于治疗前,差异有统计学意义(P<0.05)。结论CH包括暂时性和永久性的,暂时性CH患儿甲状腺基本正常,永久性CH的病因较多,包括甲状腺发育不良、摄锝功能低下等。不同病因患儿TSH水平有较大差异。CH确诊后给予L-T4治疗,可明显改善甲状腺功能。

Objective:The cause of congenital hypothyroidism(CH)was analyzed,and the prognosis after treatment with levothyroxine sodium(L-T4)was evaluated.Methods:Select our June 2013-June 2017,126 cases of children with CH as the research object,an immediate L-T4 treatment after diagnosis were performed after 24 months laboratory examination,serum thyroid function relevant indicators and combined with ultrasound and radionuclide 99 mtco4 method to clear the cause of static images,comparison of serum thyroid hormone levels in children with different etiologies and before and 24 months after treatment serum thyroid hormone level changes.Results:In children with 126 cases,121 cases of completed 24 months of treatment and follow-up,determination of related parameters of thyroid function after 1 month of stopping medication combined with bone age development,thyroid scan results comprehensive diagnosis,including 73 cases of permanent CH causes constitute the basic normal thyroid respectively 15.07%,53.42%19.18%technetium function is low,the ectopic thyroid and thyroid deficiency such as 5.48%and 6.85%thyroid dysplasia,48 cases of children with temporary CH 100%basic normal thyroid,temporary and permanent CH children cause difference was statistically significant(P<0.05).TSH level of permanent CH children was higher than that of temporary CH children,and FT4 level was lower than that of temporary CH children,the difference was statistically significant(P<0.05).There was no significant difference in FT3 level between the two groups(P>0.05).In children with permanent CH,TSH level was higher than that of children with normal thyroid,and FT4 level was lower than that of children with normal thyroid,with statistically significant differences(P<0.05).The normal rate of temporary CH bone age was 72.92%,which was significantly higher than that of permanent CH(27.40%),and the difference was statistically significant(P<0.05).The TSH level of children with thyroid deficiency and ectopic thyroid was higher than that of children with thyroid dysplasia and low technetography,and the difference was statistically significant(P<0.05).After 24 months of treatment,TSH level of CH children was lower than that before treatment,while FT4 level was higher than that before treatment(P<0.05).Conclusion:CH includes temporary and permanent.The thyroid of children with temporary CH is basically normal,and there are many causes of permanent CH,including thyroid dysplasia and low technetium uptake.TSH levels of children with different etiologies were significantly different.L-t4 treatment after CH diagnosis can significantly improve thyroid function.