先天性甲状腺功能低下症疗效评估及相关因素分析

Analysis of the curative effect of congenital hypothyroidism children

【目的】分析经新生儿疾病筛查程序诊治的甲状腺功能减低症(congenital hypothyroidism,CH)患儿的神经心理发育情况,为正确评估预后、探索更完善的治疗方案提供依据。【方法】采用首都儿科研究所研制的0～6岁婴幼儿神经、心理发育诊断量表对CH患儿的发育商和大运动、精细动作、适应能力、语言、社交行为五大能区进行评价。【结果】经新生儿疾病筛查程序诊治的CH患儿神经心理发育水平大部分处于正常水平,各年龄段的CH患儿平均发育商都在85分以上,但是接近正常范围的下限。不同诊断年龄对3岁以内患儿的神经心理发育影响差异无统计学意义。患儿确诊时FT3水平与精细动作、适应能力、语言、社交行为得分呈负相关(r值分别为-0.282、-0.280、-0.276、-0.192,P值均<0.05),患儿确诊时FT4水平与大运动得分呈正相关(r=0.198,P<0.05)。【结论】经新生儿疾病筛查程序诊治的CH患儿智能水平大部分可达到正常水平,确诊时FT3水平高和FT4水平低均可能影响患儿的神经心理发育。

[Objective] To analyze the neural and psychological development of congenital hypothyroidism （CH） children from the newborn screening for CH,and provide evidences for estimating prognosis and exploring more perfect treatment. [Method] The DQ, motor, fine movement, adaption, language and social behavior of congenital hypothyroidism children were evaluated using neural and psychological development diagnosis scale for 0--6 years old children. [Results] Intelligence level of most CH children was in normal range,average scores of DQ were higher than 85 but in low-to-nor- mal level in each age group. Neural and psychological development of CH children of different diagnosis age were not significant- ly different. The correlations between pretreatment FT3 and fine movement, adaption, language, social behavior were significant （P〈0.05）, and the correlation coefficients were -0. 282 ,-0. 280 ,-0. 276 ,-0. 192, respectively. The correlation between pretreatment FT4 and motor was significant （r=0. 198,P〈0.05）. [Conclusion] Intelligence level of most CH children can achieve normal range. Both high FT3 level and low FT4 level can affect the neural and psychological developments of CH children.