学龄前先天性甲状腺功能减低症患儿生长发育及其影响因素的研究

Analysis of physical growth and interference factors in preschool children with early-treated congenital hypothyroidism

目的分析甲状腺激素替代治疗后的学龄前先天性甲状腺功能减低症congenital hypothyroidism(CH)患儿体格、骨龄发育状况及其影响因素,以进一步完善治疗方案,提高治疗效果。方法选取青岛市经新生儿筛查确诊的持续性甲低患儿(病例组)47例(年龄4.92±0.79岁)及性别、年龄与之相匹配的正常儿童58例(年龄5.17±0.66岁)作为研究对象,采用自制的一般情况调查问卷、骨龄评定手册进行调查分析。结果①两组儿童的体重、身高、坐高和头围均在正常范围,但差异均有统计学意义(P<0.05,或P<0.01),②病例组儿童平均骨龄明显低于对照组,差别有统计学意义(P=0.006)。③病例组儿童骨龄与初始治疗剂量及治疗前FT4浓度呈显著正相关(P均<0.05)。结论经过新生儿筛查得到早期诊断和治疗的CH患儿,在学龄前期,身高、体重在正常范围之内,但仍落后于正常儿童;骨龄发育水平与初始治疗剂量、治疗前的甲状腺激素浓度(FT4)有关;在对CH患儿早期足量甲状腺激素替代治疗时,应重视骨龄、身高、体重的监测,及时调整治疗方案,以获得满意的治疗效果。

Objective：To evaluate physical growth and interference factors in preschool children with early-treated congenital hypothyroidism（CH）,so as to improve treatment result of CH.Methods：A historical cohort study was performed in 4-6 years old children with CH detected by neonatal screening in Qingdao.47 children with permanent CH were studied and compared to 58 matched normal children born at the same time.The related factors of the two groups were investigated by self-made questionnaires,children respectively.Results： ①In preschool,the children with CH were significantly lower than the control group in the weight,height（P〈0.05,或P〈0.01）,but they are in normal range.② the bone age of CH were significantly lower than the control group（P=0.006）.③the bone age of CH were positive correlated with initial therapy dosage and pretherapy FT4 level.Conclusion：It is found that the children with congenital hypothyroidism were lower than the control group in the weight,height,sitting height and head circumference.the bone ages of CH children should be concerned with initial therapy dosage and pretherapy FT4 level,in order to obtain satisfactory therapeutic effect,attention should be paid to bone age,height and weight.