儿童自身免疫性甲状腺疾病120例临床诊治和相关因素分析

Analysis of diagnosis and therapy and correlation factors of 120 children with autoimmunity thyroid disease

目的:探讨儿童自身免疫性甲状腺疾病(AITD)包括Graves病(GD)和慢性淋巴细胞性甲状腺炎(HT)的患病特点、临床表现、缓解和复发趋势、诊治规律,为更好地指导临床。方法:收集1994年至2008年3月儿科内分泌门诊资料完整的病例120例,其中HT78例,GD42例,按TANNER分期将患病年龄分为青春前期和青春期,比较HT和GD不同时期的患病率。对HT组比较初发病时甲状腺激素水平,并按照不同发病年龄比较其抗体滴度水平,进行HT组甲状腺激素水平和抗体滴度的Pearson相关性分析。超声波测量HT和GD两组甲状腺肿体积比较大小。结果:78例HT病人中男女比例为1:5。HT组初发病时甲状腺激素水平明显不同。HT组病人TGAb和TMAb阳性滴度比较,青春前期患病者高于青春期患病者(P<0.01),有统计学意义。相关性分析显示HT组FT3与FT4水平呈正相关(P<0.01),TGAb和TMAb滴度水平呈正相关(P<0.01),均有统计学意义。GD组病人男女比例为1:1.6。HT青春前期患病率高于GD组(P<0.05),有统计学意义。全部患儿均有不同程度的甲肿,但甲肿体积两组比较无明显差别(P>0.05)。结论:HT组病人患病率女明显高于男。青春期患病率高考虑与青春发育期内分泌容易紊乱有关。患病年龄越小儿童的病情越重,治疗时间越长,治愈越困难。

Objective： To explore onset feature,clinical manifestations, the tendency of remission and recurrence ,diagnosis and therapy of children with autoimmunity thyroid disease including Graves Disease （GD） and Hashimotos Thyroiditis （HT） and guide clinic better. Methods： The cases of pediatric endocrine clinic were collected from January 1994 to March 2008, which included 78 cases with HT and 42 cases with GD.According to their onset age, they were derided into prepuberty group and puberty group by Tanner staging .The morbidity rate of two groups, the level of thyroid hormone of HT patients onset and the level of antibody titer according to their onset age were observed. Pearson relationship analysis between the level of thyroid hormone and the level of antibody titer were made. Goitrous volume was determined by ultrasonometry between GD group and HT group and compared. Results： （1） In 78 patients with HT the ratio of sex was 1：5.The level of thyroid hormone was different in HT group when they were initial patients. The titer of TGAb and TMAb in prepuberty patients was higher than that in puberty patients （P〈0.01）.The level of FT3 and FT4 in HT group was positive correlation（P〈0.01）.The titer of TGAb and TMAb was positive correlation （P〈0.01）.（2）In 42 patients with GD the ratio of sex was 1：1.6.The prepuberty morbidity rate in HT group was higher than that in GD group （P〈0.05）. （3）All patients had different degree goiter ,but there was no significant difference between HT group and GD group（P〉0,05）. Conclusion： The morbidity rate of girls is higher than boys＇ in HT group. The puberty morbidity rate is higher which is considered that is concernd with endocrine disorder. The titer of TGAb and TMAb in prepuberty patients is higher which suggest that the younger with disease,the longer of therapy and the more difficult to cure.