神木地区先天性甲低儿童干预效果的病例对照分析

Case-control analysis of intervention effect on children with congenital hypothyroidism in Shenmu

目的分析经治疗、随访及健康干预的先天性甲状腺功能低下症(简称先天性甲低)儿童的生长发育相关指标,为临床防治提供参考价值。方法选取神木地区2010年1月至2017年12月新生儿疾病筛查工作中先天性甲低患儿的资料,进行回顾性分析。将确诊为先天性甲低的19例患儿设为病例组,平均年龄(4.40±1.97)岁,予以健康教育、治疗及随访等干预措施;同时按1:3的比例选取年龄、性别、地域特点一致的健康查体儿童57例为对照组,平均年龄(4.44±1.96)岁。比较两组儿童体格生长、智力发育相关指标的差异并对影响因素进行分析。结果病例组患儿经干预后,体重在百分位表中处于P10~P50的水平,身高在百分位表中处于P10~P50的水平,均在正常范围内;但在体重(15.52±2.80kg)、身高(104.20±4.87cm)和智力发育总分(89.71±6.07)的比较上,均落后于对照组的体重(18.35±2.92 kg)、身高(108.29±5.52cm)和智力发育(103.39±1.85),差异均有统计学意义(t值分别为14.570、29.410、150.457,均P<0.01)。在影响体格发育、智力发育的因素方面,两组在分娩方式、窒息情况和家庭人均月收入方面差异均无统计学意义(均P>0.05),而在随访情况和父母育儿态度上差异均有统计学意义(χ~2值分别为11.928、11.992,均P<0.05)。结论对新生儿疾病筛查确诊的先天性甲低患儿实施早期干预,其体格生长、智力发育虽然落后于同年龄儿童,但增长水平明显进步。随访过程中加强疾病防治的健康宣教非常重要。

Objective To analyze the growth and development related indexes of children with congenital hypothyroidism（CH）after treatment,follow-up and health intervention so as to provide reference for clinical prevention and treatment.Methods Data of CH children detected in neonatal disease screening in Shenmu area from January 2010 to December 2017 were analyzed retrospectively.Nineteen children diagnosed with CH were set as case group,and average age of them was（4.40±1.97）years.Intervention measures such as health education,treatment and follow-up were given to them.At the same time,57 cases of healthy children with same age,gender and geographical characteristics were selected as control group with proportion of CH children to healthy children at 1：3.Average age of healthy children was（4.44±1.96）years.Differences in physical growth and intelligence development indexes between two groups were compared and influencing factors were analyzed.Results Weights of children in case group were between P10 and P50 and heights were between P10 and P50 in percentile table after drug intervention,and both were in normal range.But weight（15.52±2.80）kg,height（104.20±4.87）cm and total intellectual development score（89.71±6.07）in case group were lower than weight（18.35±2.92）kg,height（108.29±5.52）cm and total intellectual development score（103.39±1.85）in control group,and t values were 14.57,29.41 and 150.457 respectively,which were significantly different（all P〈0.01）.In terms of the influencing factors of physical development and intellectual development,there were no significant differences between two groups in delivery mode,neonatal asphyxia and family per capita monthly income（all P〈0.05）,but there were significant differences in follow-up and parenting attitude between two groups（χ~2 value was 11.928 and 11.992,respectively,both P〈0.05）.Conclusion Although CH children detected in neonatal disease screening have lower physical and intellectual development levels than normal children after receiving early intervention,their growth obviously improved.It is very important to strengthen health education on disease prevention during follow-up.