早期补充小剂量LT4对早产儿暂时性甲状腺功能低下的临床疗效及安全性

Clinical effect and safety of early supplementation with low dose LT_4 in transient hypothyroidism in preterm infants

目的探讨早期补充小剂量左旋甲状腺素钠(LT_4)对早产儿暂时性甲状腺功能低下的临床疗效及安全性。方法选取早产儿148例,其中诊断为早产儿暂时性甲状腺功能低下的患儿64例,应用随机数字表法随机分为治疗组和非治疗组,各32例。非治疗组给予基础治疗,治疗组予以早期补充小剂量LT_4治疗,观察并记录所有患者甲状腺激素水平、临床指标及智力量表,同时对比生长发育及并发症状况。结果非治疗组不同时间点游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、三碘甲状腺原氨酸(triiodothyronine,T_3)、游离甲状腺素(free thyroxine,FT_4)、甲状腺素(thyroxine,T_4)升高,治疗组不同时间点FT_3、T_3、FT_4、T_4、促甲状腺素(thyrotropin,TSH)升高,随着治疗时间延长,与非治疗组比较,治疗组治疗7、14、21 d时FT_3、FT_4较高,治疗14、21 d时T_3、T_4较高,治疗21 d时TSH较高,差异具有统计学意义(P<0.05);治疗组达全胃肠喂养时间、光疗总时间及住院时间较短,新生儿神经行为测定评分法(neonatal behavioral neurological assessment,NBNA)较高,治疗后6个月生长发育状况(身高、体质量、头围生长),治疗后2年中国修订韦氏儿童智力量表(Chinese Wechsler Young Children scale of Intelligence,C-WYCSI)评分更显著,差异具有统计学意义(P<0.05)。结论早期补充小剂量LT4对早产儿暂时性甲状腺功能低下疗效确切,有助促进其神经系统发育。

Objective To investigate the clinical effect and safety of early supplementation with low dose levothyroxine sodium（LT4） in the treatment of transient hypothyroidism in preterm infants. Methods 148 cases of preterm infants of which 64 cases with transient hypothyroidism,according to the random number table method,they were divided into 2 groups,32 cases of each group. Non-treatment group received basic treatment,treatment group received early low-dose LT4 treatment,thyroid hormone levels,clinical indicators and intelligence scale were observed and recorded,and growth and complications were compared. Results The free triiodothyronine（FT3）,triiodothyronine（T3）,free thyroxine（FT4） and thyroxine（T4） in non-treatment group signigifantly increased at different time points,and FT3,T3,FT4,T4 and thyrotropin（FSH） signigifantly increased in the treatment group at different time points,and with the extension of treatment time,FT3,FT4 in the treatment group of 7,14,21 d were higher than the non-treatment group,T3,T4 in the treatment group of 14,21 d were higher,and TSH was higher in 21 d,all with statistical significance（P 〈0. 05）. Compared with non-treatment group,arrival of full gastrointestinal feeding time,phototherapy time and hospitalization time were shorter in the treatment group,neonatal behavioral neurological assessment（NBNA） was higher,growth development status（height,weight,head circumference growth） after treatment 6months,and Chinese Wechsler Young Children scale of Intelligence（C-WYCSI） after 2 years were higher,all with statistical significance（P 〈0. 05）.Conclusion Early supplementation with low dose LT4 in the treatment of transient hypothyroidism in preterm infants was effective,and it was helpful to promote the development of the nervous system.