婴幼儿甲状腺功能减退症管理路径及其效果研究

Infant and Young Child Hypothyroidism Management Path and Its Effect

目的:评估甲状腺功能减退症(CH)的筛查、早期诊断及治疗管理路径的合理性。方法:回顾分析5年来对新生儿期CH筛查、早期诊断及治疗的管理路径,对召回儿童进行专案管理的资料进行系统的对比分析,找出最佳用药剂量与最佳监测项目间的关系。结果:从甲状腺功能低下和高TSH血症治疗用药的首剂用药量、首次用药稳定量、3m～、6m～、直至48 m各个时段的用药量,30m～以内均显示出差异性(P<0.05);且甲状腺功能低下治疗用药的各个时段均有极显著性差异(P<0.01)。用药剂量调整幅度在3～6m、6～9m有差异显著性(P<0.05),在9～12m后各个时段用药剂量调整幅度则无差异显著性(P>0.05)。CH患者治疗后在3月龄、6月龄、8月龄、1岁、2岁和3岁与正常婴幼儿在体重、身长、智能发育、神经反射发育方面无差异显著性(P>0.05),在骨强度、骨碱性磷酸酶、铁和锌元素方面,CH和高TSH患者则有显著差异性(P<0.05)。结论:婴幼儿CH的早期筛查、诊断及治疗对婴幼儿的健康成长具有重要意义。

Objective：Assess the reasonableness of neonatal screening,early diagnosis and treatment management path.Methods：A retrospective analysis of 5 years of management path of neonatal screening,early diagnosis and treatment of CH,Systematically comparative analysis the project management data of recall children,find out the relation between the optimal dose and the best monitoring project.Results： From the low thyroid function and high TSH level treatments first agent dosage,the first drug stability,3M~,6m~,until 48 m each time,dosage,30m~ within showed difference（P＆lt;0.05）;and low thyroid function and treatment of all time was significant the difference（P＆lt;0.01）.Dosage adjustment in 3~6m,6~9m,there were significant differences（P＆lt;0.05）,in 9~12m after every time dosage adjustment has no significant difference（P＆gt;0.05）.The treatment of CH in March,June,August age old age,at the age of 1,2 and 3 years old and normal children in body weight,height,intelligence development,neural reflex development without significant difference（P＆gt;0.05）,and in the aspect of bone strength,bone alkaline phosphatase,iron and zinc,high CH patients with TSH had significant difference（P＆lt;0.05）.Conclusions：CH infants early screening,diagnosis and treatment of infants and young children is important for the healthy growth.