先天性甲状腺功能减低症治疗前后TSH、FT4、IGF-1水平的变化及与体格生长的关系

Relationship between physical development and changes of TSH,FT4 and IGF-1 before and after treatment in children with congenital hypothyroidism

【目的】了解先天性甲状腺功能减低症(congenitial hypothyroidism,CH)患儿经左甲状腺素钠替代治疗前后血清中胰岛素样生长因子-1(IGF-1)、促甲状腺激素(thyroid stimulating hormone,TSH)和游离甲状腺素(free thyrox-ine,FT4)水平的变化,并分析这些指标对CH患儿体格发育的影响。【方法】采集未经治疗的27例CH新生儿和21例治疗后的CH幼儿,30例健康新生儿和30例健康幼儿(作为对照组)的外周静脉血,采用化学发光法测定各组TSH、FT4和IGF-l水平,测量各组体重、身长。【结果】CH新生儿组与健康新生儿组相比,血清IGF-1、TSH、FT4水平显著降低(P<0.05)。经一元线性相关分析,CH新生儿IGF-1水平与TSH、FT4、出生体重(body weight,BW)、出生身长(bodylength,BL)均无明显相关性(P>0.05)。BW、BL与TSH负相关,与FT4正相关。经规范L-T4替代治疗后的CH幼儿组与健康幼儿组相比IGF-1、TSH和FT4水平差异均无统计学意义,两组的体重及身长差异无统计学意义。【结论】TSH和FT4可能在CH胎儿期的体格生长中起一定作用。经L-T4替代治疗后TSH、FT4和IGF-1水平升高,这可能是保证CH治疗后正常生长的因素之一。

[Objective] To study the changes of serum insulin like growth factor-1 （IGF-1）,thyroid stimulating hor- mone（TSH） and free thyroxine（FT4） in children with congenital hypothyroidism（CH） by levothyroxine（L-T4） substitution therapy,and to analyse the effects on physical growth in these children. [Methods] IGF I,TSH and FT4 were detected by chemiluminescence method which were collected from 27 untreated neonatus with CH,21 children with CH after thera py,30 healthy neonatus and 30 healthy children（as controls）. Body weight （BW） and body length （BL） of each groups were measured. [Results] The levels of serum IGF-1,TSH and FT4 in neonatus with CH were significantly lower than those in healthy neonatus （P〈0.05） while there were not differ between healthy children and children with CH after therapy （P 〉0.05）. TSH, FT4 ,BW and BL had no correlations with IGF-1. BW and BL had inverse correlations with TSH while direct correlations with FT4 in neonatus with CH. [Conclusions] Physical growth of children with CH in fetal period may be af- fected by TSH and FT4. The normal levels of TSH, FT4 and IGF-1 may be possible factors for normal growth of children with CH.