影响先天性甲状腺功能减低症不同转归的早期因素

The early factors influencing different outcomes of congenital hypothyroidism

目的探讨影响先天性甲状腺功能减低症患儿不同转归的早期因素。方法选取2013年12月—2017年3月期间在本中心筛查并确诊的先天性甲状腺功能减低症患儿共80例,经左旋甲状腺激素钠治疗2~3年后停药评估再随访1年以上者,根据疾病转归将患儿分为持续性甲低组(29例)与暂时性甲低组(51例)。对2组患儿的临床情况进行回顾性分析,寻求影响结局的早期因素。结果持续性甲低与暂时性甲低患儿初筛促甲状腺激素值[63.89(43.89,114.25)vs 38.54(27.27,60.00)mIU/L]、促甲状腺激素恢复正常所需剂量[(4.29±1.46)vs(3.38±1.34)μg/(kg·d)]、早期甲状腺超声正常比例[58.6%(17/29)vs 90.2%(46/51)]差异有统计学意义(P<0.05)。其中初筛促甲状腺激素值(最佳临界值:37.825 mIU/L,AUC=0.745,灵敏度0.897,特异度0.490)和出生后第8个月左旋甲状腺激素钠给药剂量[最佳临界值3.38μg/(kg·d),AUC=0.759,灵敏度0.586,特异度0.843]可早期区别持续性甲低与暂时性甲低患儿。结论初筛促甲状腺激素值和出生后左旋甲状腺激素钠给药剂量对先天性甲状腺功能减低症患儿临床转归有早期预测作用。

Objective To investigate the early factors affecting different outcomes of children with congenital hypothyroidism(CH).Methods A total of 80 children with CH screened and diagnosed at Meizhou Maternal and Child Health Care and Family Planning Service Center between December 2013 and March 2017,who were treated with levothyroxine sodium for 2~3 years and then discontinued for assessment and followed up for over 1 year,were selected and divided into the permanent CH group(29 cases)and transient CH group(51 cases)according to disease outcomes.The clinical conditions of the children were retrospectively analysed to seek early factors affecting outcome.Results The initial screening thyroid hormone values[63.89(43.89,114.25)vs 38.54(27.27,60.00)mIU/L],the required dose to restore normal thyroid hormone in permanent and transient CH group[(4.29±1.46)vs(3.38±1.34)μg/(kg·d)],and the proportion of early normal thyroid ultrasound[58.6%(17/29)vs 90.2%(46/51)]had significant differences(P<0.05).The initial screening thyroid hormone value(optimal threshold:37.825 mIU/L,AUC=0.745,sensitivity 0.897 and specificity 0.490)and the levothyroxine sodium dosage at eighth month of age[optimal threshold 3.38μg/(kg·d),AUC=0.759,sensitivity 0.586 and specificity 0.843]could early distinguish permanent and transient CH children.Conclusions Initial screening thyroid hormone values and postnatal levothyroxine sodium dosage had an early predictive effect on clinical outcome in children with CH.