左旋甲状腺素治疗新生儿先天性甲状腺功能减退体、智发育的远期疗效

Long-term effects of L-T4 treatment on physical and intellectual development for congenital hypothyroidism

观察长期左旋甲状腺素（L-T4）治疗对新生儿先天性甲状腺功能减退患者体、智发育的影响，探讨青春期和成年后的远期疗效。15例早年患者中14例是筛查发现，现年15～31岁，男9例、女6例。（1）治疗10多年至青春期时，回访年龄12．6～18．1岁，患者身高14例正常，体重8例正常，6例超重，只筛查出的首例患者身高154cm，体重43．5kg，均低于标准。X线骨龄9例正常，1例发育较快，4例左腕骨龄发育迟缓。智商联合型瑞文测验（CRT）3例优良，7例正常，3例边缘，2例低下。综上14例筛查中1例体、智发育迟滞占7％，而93％患者处在基本正常发育过程。（2）接受20多年治疗进入成年期的13例患者中4例失访，回访的9例（8例是筛查出的）年龄23～31岁，男5例、女4例，身高和x线骨龄全部正常，体重基本正常，只2例体重指数轻微超重。智商7例良好，2例轻度低下。7例患者接受了中等以上的教育，除1例在学。余均就职。1例小学毕业后学国画出师售画，1例初小毕业务农，每人都是胜任其职的劳动者。综上8例筛查的患者中1例为智力轻度低下，占12．5％，而87．5％的患者体、智都达健康人群水准。

To explore the long-term effects of L-T4 treatment on physical and intellectual development in neonatal congenital hypothyroidism （CH） patients during adolescence and adulthood. 14 out of 15 patients, aged 15-31 years old, including 9 males and 6 females, were diagnosed by neonatal screening for congenital hypothyroidism. （ 1 ） By treatment for 10 years until adolescence, return visit ages were 12.6-18. 1 years old, the height of patients were normal in 14 cases, weight normal in 8 cases, and overweight in 6 cases. Only the first patient of neonatal screening for congenital hypothyroidism height 154 cm, weight of 43. 5 kg, which were below the standard. Bone age by X-ray showed 9 normal, 1 case of rapid development, 4 cases with left wrist bone age retardation. IQ combined Raven＇s test（CRT） showed 3 cases excellent, 7 cases normal, 3 cases borderline, and 2 cases low. （2） Treatment for more than 20 years to adulthood, 9 cases of return visits （ 8 cases were screened out） by 23-31 years of age, with 5 males and 4 females, height and bone age were all normal, normal weight, only 2 cases BMI slightly overweight. As to IQ, good were in 7 cases, mild retardation in 2 cases. 7 patients received above average education; they were all employed except one. The employed patients were all capable for their jobs. In summary, screening out of 8 patients, 1 case were of mild mental retardation （ 12.5% ） ; while 7 patients（ 87.5% ）, both in physical and intellectual levels were as those of the normal population.