先天性甲状腺功能减退症患儿甲状腺功能的临床研究

Clinical study on thyroid function in children with congenital hypothyroidism

目的探讨先天性甲状腺功能减退症患儿甲状腺功能及体格生长、心理行为发育状况。方法选择2014年1月至2018年12月于余姚市人民医院分娩的先天性甲状腺功能减退症患儿32例作为观察组,并选择同期分娩的30例健康新生儿作为对照组。比较两组甲状腺功能指标的变化、1岁时体格发育、骨龄、智力发育、神经心理发育的情况。结果观察组出生时促甲状腺激素(TSH)为(18.23±2.71)mU/L,明显高于对照组的(2.85±0.34)mU/L,游离甲状腺素(FT_(4))为(6.76±1.54)pmol/L,明显低于对照组的(17.91±2.04)pmol/L,差异均有统计学意义(t=30.84、24.39,均P<0.001);观察组1岁时TSH、FT_(4)分别为(2.68±0.78)mU/L、(17.26±2.11)pmol/L,对照组分别为(2.77±0.63)mU/L、(17.54±2.20)pmol/L,差异均无统计学意义(t=0.50、0.51,均P>0.05);1岁时,观察组体质量、身长、头围、骨龄分别为(9.21±1.20)kg、(79.84±3.05)cm、(43.73±1.42)cm、(1.01±0.15)岁,均明显低于对照组的(10.12±1.32)kg、(84.54±3.41)cm、(45.85±2.04)cm、(1.14±0.28)岁,骨龄落后比例为21.88%(7/32),明显大于对照组的3.33%(1/30),差异均有统计学意义(t=2.84、5.73、4.77、2.30,χ^(2)=4.74,均P<0.05);两组1岁时智力发育情况比较,差异有统计学意义(χ^(2)=7.05,P<0.05);观察组粗大运动、精细运动、适应能力、语言能力和社交能力分数分别为(90.43±6.96)分、(92.03±6.03)分、(88.45±4.85)分、(84.04±5.71)分、(85.05±6.17)分,均明显低于对照组的(99.47±5.40)分、(104.12±5.71)分、(98.47±5.22)分、(94.16±4.98)分、(104.34±5.70)分,差异均有统计学意义(t=5.69、8.09、7.84、7.42、12.76,均P<0.001)。结论先天性甲状腺功能减退症患儿中,存在明显的体格生长、心理行为发育障碍,临床上需加强早期筛查、治疗,以期改善患儿预后。

Objective To investigate thyroid function,physical growth,and psychological and behavioral development in children with congenital hypothyroidism.Methods Thirty-two children with congenital hypothyroidism who were born in Yuyao People's Hospital from January 2014 to December 2018 were included in the observation group.Thirty healthy neonates who were born in the same period were included in the control group.Thyroid function index changes at the age of 1 year relative to at birth,physical,intellectual,and neuropsychological development and bone age at the age of 1 year were compared between the observation and control groups.Results Thyroid-stimulating hormone level at birth was significantly higher in the observation group than in the control group[(18.23±2.71)mU/L vs.(2.85±0.34)mU/L,t=30.84,P<0.001].Free thyroxine level at birth was significantly lower in the observation group than in the control group[(6.76±1.54)pmol/L vs.(17.91±2.04)pmol/L,t=24.39,P<0.001].In the observation group,thyroid-stimulating hormone and free thyroxine levels at the age of 1 year were(2.68±0.78)mU/L and(17.26±2.11)pmol/L,respectively,which were not significantly different from those in the control group[(2.77±0.63)mU/L and(17.54±2.20)pmol/L,t=0.50,0.51,both P>0.05].Body weight,body length,head circumference,and bone age at the age of 1 year were(9.21±1.20)kg,(79.84±3.05)cm,(43.73±1.42)cm,(1.01±0.15)years old,respectively in the observation group,which were significantly lower than those in the control group[(10.12±1.32)kg,(84.54±3.41)cm,(45.85±2.04)cm,(1.14±0.28)years old,t=2.84,5.73,4.77,2.30,P<0.05].The proportion of children patients with bone age lag was significantly higher in the observation group than in the control group[21.88%(7/32)vs.3.33%(1/30),χ^(2)=4.74,P<0.05].There was a significant difference in intellectual development at the age of 1 year between the two groups(χ^(2)=7.05,P<0.05).Gross movement,fine movement,adaptability,language ability,and social ability in the observation group were scored(90.43±6.96)points,(92.03±6.03)points,(88.45±4.85)points,(84.04±5.71)points,and(85.05±6.17)points,respectively,which were significantly lower than those in the control group[(99.47±5.40)points,(104.12±5.71)points,(98.47±5.22)points,(94.16±4.98)points,and(104.34±5.70)points(t=5.69,8.09,7.84,7.42,12.76,all P<0.001].Conclusion Neonate patients with congenital hypothyroidism have obvious physical growth and psychological and behavioral development disorders.Early screening and treatment of neonatal congenital hypothyroidism should be strengthened to improve the prognosis.