新疆维吾尔族地方性克汀病患者甲状腺功能的研究

Thyroid function of Uygur patients with local Curtin in Xinjiang

目的对新疆南疆地区维吾尔族地方性克汀病患者进行血清甲状腺激素的测定，了解地方性克汀病患者的甲状腺功能，为其诊断、治疗和预防提供依据。方法2014年9—10月，以新疆南疆地区维吾尔族地方性克汀病患者188人为病例组（根据病理类型进一步分为神经型、黏液水肿型、混合型组，分别为144、19、25人），当地健康者121人为对照组，地方性克汀病病例组的母亲125人为母亲组，所有研究对象抽取3ml静脉血，使用全自动电化学发光免疫分析仪对研究对象的促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（隅）、游离甲状腺素（FT4）、甲状腺球蛋白抗体（A-TG）、抗甲状腺过氧化物酶抗体（A-TPO）7项甲状腺功能指标进行检测。结果神经型、黏液水肿型、混合型克汀病患者和对照组4组人群甲状腺功能5项指标（T3、T4、FT3、FT4、TSH）比较差异均有统计学意义（F=22．92、42．58、38．84、56．31、103．29，P均〈0．05），神经型地方性克汀病患者T3、T4、TF4[（2．41±0．48）、（118．72《中国黄金珠宝》编辑部20．92）nmol／L，（5．25±0．98）、（15．81±2．60）pmol／L]均明显高于黏液水肿型地方性克汀病患者[（1．51±0．73）、（39．25±16．95）nmol／L，（3．02±1．05）、（6．42±1．99）pmol／L，P均〈0．05]，TSH低于黏液水肿型患者[（2．26±1．04）比（58．56±24．83）mU／L，P〈0．05]；混合型地方性克汀病患者T3、T4、FT3、FT4[（2．38±0．38）、（120．77±21．55）nmol／L，（5．14±0．83）、（15．58±2．99）pmol／L]均明显高于黏液水肿型地方性克汀病患者（P均〈0．05），TSH低于黏液水肿型患者[（2．83±0．91）mU／L，P〈0．05]；黏液水肿型患者T3、T4、FT3、FT4均明显低于对照组[（2．53±0．50）、（121．93±22．01）nmol／L，（5．49±0．82）、（15．93±2．76）pmol／L，P均〈0．05]，而TSH高于对照组[（2．94±1．17）mU/L，P〈0．05]。神经型患者TSH[（2．05±1．45）mU／L]明显低于其母亲组[（2．27±1．63）mU／L，t=10．57，P〈0．05]；黏液水肿型患者T3、T4、FT3、FT4[（1．81±0．66）、（56．73±29．56）nmol／L，（2．97±1．34）、（5．95±2．74）pmol／L]均明显低于其母亲组[（2．16±0．35）、（125．48±24．78）nmol／L，（4．29±0．42）、（14．90±2．38）pmol／L]，而TSH[（57．72±44．69）mU／L]高于其母亲组[（2．35±0．56）mU／L]，差异有统计学意义（t=7．59、7．07、16．07、10．95、245．23，P均〈0．05]。3种类型的克汀病患者及对照组4组人群A-TG、A—TPO阳性率比较差异无统计学意义（x2=1．60、3．64，P均〉0．05）。结论3种类型的地方性克汀病患者中神经型患者和混合型患者具有正常的甲状腺功能，黏液水肿型患者表现明显的甲状腺功能减低。

Objective To determine the serum thyroid hormone level of Uygur patients with local Curtin in southern Xinjiang region, to understand the thyroid function of Curtin disease in terms of diagnosis, treatment and prevention and to provide a background information. Methods One hundred and eighty-eight Uygur endemic cretinism were selected as cases [divided into neural （14d）, myxedematous （19）, mixed type groups （25）], 121 local healthy people as control group, 125 mothers of the case group as mother group from southern Xinjiang region from September 2014 to October 2014, 3 ml venous blood sample was collected of each subject, serum thyroid stimulating hormone （TSH）, triiodothyronine （T3）, tyroxine （T4）, free triiodothyonine （FT3）, free tyroxine （FT4）, anti-thyroglobulin antibody （A-TG）, and thyroid peroxidase antibody （A-TPO） levels were tested. Results There were statistically significant differences of the thyroid function index （T3, T4, FT3, FT4） between the four groups （neural, myxedematous type, mixed type cretinism patients and control groups, F = 22.92, 42.58, 38.84, 56.31, 103.29, all P 〈 0.05）. Levels of T3, T4, FT3, FT4 [（2.41 ± 0.48）, （118.72 ± 20.92）nmol/L, （5.25 ± 0.98）, （15.81 ± 2.60）pmol/L] in neural type patients were significantly higher than those of myxedematous type patients [（1.51 ± 0.73）, （39.25 ± 16.95）nmol/L, （3.02 ± 1.05）, （6.42 ± 1.99）pmo]/L], TSH was lower than that of myxedematous type patients [（2.26 ± 1.04） vs. （58.56 ± 24.83）mU/L, all P 〈 0.05]; mixed type patients T3, T4, FT3, FT4 [（2.38 ± 0.38）, （120.77 ± 21.55）nmol/L, （5.14 ± 0.83）, （15.58 ± 2.99）pmol/L] were significantly higher than those of myxedematous type patients, TSH was lower than that of myxedematous type patients [（2.83 ± 0.91） vs. （58.56 ± 24.83） mU/L, all P 〈 0.05]; myxedematous type patients T3, T4, FT3, FT4 were significantly lower than those of control group [（2.53 ± 0.50）, （121.93 ± 22.01）nmol/L, （5.49 ± 0.82）, （15.93 ± 2.76） pmol/L], and TSH was higher than that of control group [（2.94 ± 1.17）mU/L, all P 〈 0.05]. TSH of neural type patients [（2.05 ± 1.45）mU/L] was lower than that of mother group [（2.27 ± 1.63）mU/L, t = 10.57, P 〈 0.05]; T3, T4, FT3, FT4 of myxedematous type patients [（1.81 ＋ 0.66）, （56.73 ± 29.56）nmol/L, （2.97 ± 1.34）, （5.95 _＋ 2.74）pmol/L] were significantly lower than those of mother group [（2.16 ± 0.35）, （125.48 ± 24.78）nmol/L, （4.29 ± 0.42）, （14.90 ＋ 2.38）pmol/L], and TSH of mother group [（2.35 ± 0.56）mU/L] was lower than that of myxedematous type patients [（57.72 ± 44.69）mU/L, t = 7.59, 7.07, 16.07, 10.95, 245.23, all P 〈 0.05]. There was no significant difference in comparison of A-TG and A-TPO in the four groups （X2 = 1.60, 3.64, all P 〉 0.05）. Conclusion The neural type patients and the mixed type patients have normal thyroid function, the myxedematous type patients have obviously lower thyroid function. [Key words] Curtin disease; Thyroid function; Uygur