左甲状腺素替代疗法对甲状腺功能减退症患儿生长发育、炎症因子及激素水平的影响

Eficacy of levothyroxine replacement therapy in children with hypothyroidism

目的探讨左甲状腺素替代疗法对甲状腺功能减退症患儿的临床疗效。方法选取2015年4月至2016年12月在温州市中西医结合医院儿科就诊的45例甲状腺功能减低症患儿为观察组，同期体检的45例健康儿童为对照组。对照组患儿常规饮食，注意营养均衡；观察组患儿在饮食指导的基础上给予左甲状腺素钠，连续治疗6个月。对两组患儿治疗前后甲状腺功能、胰岛素样生长因子、生长发育及炎症因子水平进行检测。结果治疗3个月及6个月后，观察组患儿FT3、FT4、IGF-1、IGFBP-3及IGF-1／IGFBP-3水平均较治疗前显著上升，TSH水平较治疗前显著降低，差异有统计学意义（P〈0．05）。观察组患儿治疗6个月后FT3、FT4、TSH、IGF-1、IGFBP-3及IGF-1/IGFBP-3水平分别为：（7．17±0．06）pmol／L、（18．27±1．05）pmol/L、（2．74±0．07）mU/L、（207．67±9．06）μg/L、（0．46±0．02）mg／L及（34．59±1．97），与对照组相比差异无统计学意义（P〉0．05）；治疗3个月及6个月后，观察组患儿身高、体重、骨钙素及1，25-（OH）2D3水平均较治疗前显著升高，差异有统计学意义（R0．05），且治疗6个月后与对照组相比差异无统计学意义（P〉0．05）。结论左甲状腺激素替代治疗能显著改善甲状腺功能低下患儿甲状腺功能，增加甲状腺相关激素及胰岛素样生长因子的水平，促进患儿生长发育，效果显著，值得临床进一步推广应用。

Objective To investigate the clinical efficacy of levothyroxine replacement therapy in children with hypothyroidism. Methods 45 children with hypothyroidism admitted from Apr. 2015 to Dec. 2016 were selected as observation group, and 45 healthy children in the same period were selected as the control group. Children in the control group received regular diet and were paid attention to nutritional balance. Children in the observation group were given levothyroxine sodium on the basis of dietary guidance. The two groups were treated continuously for 6 months. The levels of thyroid function, insulin-like growth factor, indicators for growth and development and inflammatory factors were measured before and after treatment in both groups. Results After treatment for 3 months and 6 months, the levels of FF3, FT4, IGF-1, IGFBP-3 and IGF-1/IGFBP-3 in the observation group increased significantly compared with those before treatment, and the levels of TSH in the observation group decreased significantly（P〈0.05）. The levels of FT3, FT4, TSH, IGF-1, IGFBP-3 and IGF-1/IGFBP-3 in the observation group after treatment for 6 months were （7.17±0.06）pmol/L, （2.74±0.07）mU/L, （207.67±9.06）μg/L, （0.46±0.02） mg/L and（34.59±1.97）. The difference was not statistically significant （P〉0.05）. After 3 months and 6 months of treatment, the height, body weight, osteocalcin and 25-（OH）2D3 levels in the observation group were significantly higher than those in the control group （P〈0.05）, and there was no significant difference between the two groups after 6 months （P〉0.05）. The difference was statistically significant （P〈0.05）. Conclusion Left thyroid hormone replacement therapy can significantly improve the thyroid function of children with hypothyroidism, increase the level of thyroid-associated hormone and insulin-like growth factor, promote the growth and development of children, which is worthy of clinical application.