新生儿缺氧缺血性脑病甲状腺功能变化及替代治疗

Alteration of thyroid function and replacement therapy in neonatal hypoxic-ischemic encephalopathy

目的 探讨新生儿缺氧缺血性脑病 (HIE)甲状腺功能的变化以及甲状腺素替代治疗对预后的影响。方法 应用放射免疫方法对 HIE患儿 3日龄、7日龄及应用甲状腺素替代治疗的 14日龄患儿血清甲状腺激素水平进行动态观察 ,并将 7日龄时血清甲状腺激素水平低下者随机分为 2组 ,对照组继续 HIE常规治疗 ,治疗组在此基础上加用甲状腺片治疗 ,通过观察体温、进乳量的改善、体重的变化以及应用新生儿行为神经测查法 (NBNA)进行评估。结果 3日龄时中、重度 HIE患儿血清 T3显著低下 ,各组间有显著性差异 ,7日龄时重度组 T3仍显著下降 ,应用甲状腺素替代治疗组与常规治疗组相比 NBNA评分、预后判定及进乳量的改善上均有显著性差异。结论 中、重度新生儿 HIE伴随甲状腺功能降低 ,且与疾病严重程度呈正相关 ,恢复期 (7日龄 )甲状腺功能不恢复者应用甲状腺片替代治疗可促进病情恢复 ,改善预后。

Objective To investigate the influence on prognosis of neonatal hypoxic ischemic encephalopathy through observing the alternation of thyroid function and implementing the replacement therapy of thyroxine. Methods The radioimmunoassay was applied to observe a series of changes in serous thyroxine levels of patients aged 3 days, aged 7 days and patients aged 14 days who received thyroxine replacement therapy in HIE. Patients aged 7 days with low level of serous thyroxine were randomly classified into 2 groups, control group and therapy group. The control continually accepted the regular therapy of HIE, and the therapy were given thyroxine tablets in addition to the foundmental treatment. The effect were evaluated through observing the levels of temperature, improvement of feeding amount, and alteration of weight and applying the Neonatal Behavioral Neurologic Assessment (NBNA). Results The level of serous thyroxine T 3 considerably declines in 3 day old patients with moderate and serious HIE. Significant difference was observed among the groups. The level of serous T 3 still declines significantly in 7 day old patients with serious HIE. The NBNA evaluation, predicting of prognosis and the improvement of feeding amount all exist significant difference between the thyroxine replacement therapy and the regular therapy. Conclusion The function of thyroidea has declined in patients with moderate and serious neonatal HIE, and it is positively related with the severity of the disease. If the function of thyroidea doesn't go back to its normal level until the recuperating phase, the replacement therapy with thyroxine tablets can prompt the recovering of the disease and improve the prognosis.