先天性甲状腺功能低下的学龄前患儿发育研究

A study on physical growth and psychological behavior development of preschool children with congenital hypothyroidism

目的分析先天性甲状腺功能低下(CH)的学龄前患儿在体格生长及心理行为发育等方面的特征,为相关干预模式的研究提供理论依据。方法选取2012年8月至2018年8月在德州市妇幼保健院新生儿疾病筛查中心确诊为CH的学龄前患儿40例为研究对象(研究组),对患儿行甲状腺激素的替代治疗;同时随机选取40例正常体检儿童为对照组。采用测量与量表记录的方式,对两组儿童的体格生长及心理行为发育情况进行观察分析。结果研究组患儿的体重和身高均显著低于对照组儿童(t值分别为-2.307、-3.651,均P<0.05),研究组患儿的骨龄显著低于对照组儿童(t=-2.842,P<0.05)。研究组的血清游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)浓度均显著高于对照组(t值分别为2.541、5.032均P<0.05),而血清促甲状腺激素(TSH)浓度差异无统计学意义(P>0.05)。两组儿童的全量表智商(FIQ)分布差异有统计学意义(χ^2=29.698,P<0.05)。研究组的心理行为问题发生率显著高于对照组(χ^2=13.501,P=0.000),在女童中,研究组的心理行为总分显著高于对照组(t=4.508,P<0.05);在男童中,研究组的心理行为总分显著高于对照组(t=2.241,P<0.05)。研究组中难养型气质分布高于对照组(χ^2=17.012,P<0.05)。两组家庭环境在知识性、独立性、娱乐性、成功性及亲密度方面差异均有统计学意义(t值分别为-2.741、-2.658、-2.375、-1.276、-2.658,均P<0.05)。结论对于CH患儿而言,通过疾病筛查可以于早期对其进行诊断和干预,学龄前该病患儿在体格生长和心理行为发育等方面虽然处于正常范围,然而与健康儿童相比仍存在一定的差异。因此,医务人员应进一步对干预模式进行探索。

Objective To analyze characteristics of physical growth and psychological behavior development of preschool children with congenital hypothyroidism(CH),so as to provide theoretical basis for study on relevant intervention models.Methods A total of 40preschool children diagnosed with CH in Neonatal Disease Screening Center of Dezhou Municipal Maternity and Child Health Hospital from August 2012to August 2018were enrolled as study subjects.The preschool children in the study group were treated with thyroid hormone replacement therapy.Other 40normal preschool children randomly selected were as the control group.In the study,the physical growth and psychological behavior development of the preschool children in the two groups were recorded and observed by means of measurement and scale recording.Results The height and weight of the preschool children in the study group were significantly lower than those of the preschool children in the control group(t=-2.307and-3.651respectively,both P<0.05).And the bone age of the preschool children in the study group was significantly lower than that of the preschool children in the control group(t=-2.842,P<0.05).The serum concentrations of free triiodothyronine(FT3)and free tetraiodothyronine(FT4)of the preschool children in the study group were significantly higher than those of the preschool children in the control group(t=2.541and 5.032respectively,both P<0.05).While in serum concentration of thyroid-stimulating hormone(TSH),there was no significant difference between the two groups(P>0.05).In full-scale intelligence quotient(FIQ)distribution,there was a significant difference between the two groups(χ^2=29.698,P<0.05).The incidence of psychological behavior problems of the preschool children in the study group was significantly higher than that of the preschool children in the control group(χ^2=13.501,P=0.000).The total scores in psychological behavior of both girls and boys in the study group were significantly higher than those of the girls and the boys in the control group(t=4.508and 2.241respectively,both P<0.05).Among the girls in the two groups,the psychological behavior problems mainly focused on depression,hyperactivity,obesity and aggressive behavior.While among boys in the two groups,the problems were mainly concentrated on depression,schizophrenic anxiety,violation of discipline and sexual problems.The number of children with refractory temperament in the study group was higher than that of the control group(χ^2=17.012,P<0.05).The differences in family environment such as knowledge,independence,entertainment,success and intimacy between the two groups were significant(t=-2.741,-2.658,-2.375,-1.276,and-2.658respectively,all P<0.05).Conclusion For CH of children,neonatal disease screening can diagnose and intervene the disease at early stage.Although the physical growth and psychological behavior development of those children with CH before their school age are in the normal ranges,there are some differences as compared with the healthy children with the same age.So medical personnel should further explore better intervention model of the disease.