儿童亚临床甲状腺功能减退症对智力的影响及替代治疗的价值  

Cognitive status in children with sub-clinical hypothyroidism and beneficial effect of L-T4 replacement therapy

作　　者：沈海燕[1] 朱德发[1] 曾献忠[1] 孙桂华[2] 杨欣[1] 周江宁[3] 

机构地区：[1]安徽医科大学第一附属医院老年内分泌科,合肥230022 [2]安徽医科大学第一附属医院内分泌科,合肥230022 [3]中国科学技术大学生命科学院神经生物学系,合肥230027

出　　处：《安徽医科大学学报》2006年第3期338-341,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家重点基础研究发展规划基金资助项目(编号:G1999054007)

摘　　要：目的探讨儿童亚临床甲状腺功能减退症(SCH)患者伴有智力损害情况及甲状腺激素替代治疗的价值。方法运用中国韦氏儿童智力量表(C-WISC)检测30例初诊原发性儿童SCH患者和30例正常对照者的智力水平甲状腺激素水平。其中30名患者随机分为左旋甲状腺素片治疗组和安慰剂组,干预半年后重复上述检测。结果服药前SCH患者TT3、TT4、FT3、FT4水平和智力量表测验分值显著低于正常对照组(P<0·05)。服药前后替代治疗组的分类、领悟、编码、知识、填图、言语量表、全量表总分(P<0·05)的分值增加幅度显著高于安慰剂组。半年后,替代治疗组操作量表各分测验和领悟分值仍低于正常对照组(P<0·05);而安慰剂治疗后有10个分测验分值显著低于对照组(P<0·05)。结论儿童SCH患者存在智力损害,替代治疗有助于智力水平尤其是言语能力的恢复。Objective To investigate the cognitive status in children with sub-clinical hypothyroidism and the benefit of L-T4 replacement therapy. Methods Thirty children preliminarily diagnosed with original sub-clinical hypothyroidism were randomly assigned to take L-thyroxine or placebo for 6 months. The subjects were evaluated for thyroid function and tested with C-WISC compared with thirty healthy children before and after the treatment. Results A significant cognitive impairment and thyroxine concentration decline within the normal range were found at baseline （P 〈 0. 05 ）. The enhancement in similarities, comprehension, coding （ P 〈 0. 05 ）, information, picture completion, verbal scaled score and total score （ P 〈 0. 05 ） after treatment with L-thyroxine was more significant than that with placebo. However, the situation was not completely improved after the substitution the rapy of thyroid hormone, especially on comprehension and operation score in the replacement group （ P 〈 0. 05 ）. In the placebo group, the situation was not completely improved in vocabulary, picture arrangement, coding, verbal score （P 〈 0. 05 ）, information, comprehension, picture completion, block design, operation score and total score （P 〈 0. 05）. Conclusion Children with sub-clinical hypothyroidism have a poor cognition baseline and substitution therapy can improve the cognition level especially verbal scale.

关 键 词：甲状腺功能减退症/药物疗法 甲状腺激素类/治疗应用 韦氏智力量表 智力 儿童 

分 类 号：R581.2[医药卫生—内分泌] R347.2[医药卫生—内科学]