亚临床甲状腺功能减退症患儿病因及甲状腺素干预治疗对其转归的影响  

Analysis of the Causes of Subclinical Hypothyroidism in Children and the Effects of Interventional Therapy with Thyroxine on Its Course

作　　者：张春秀[1] 何东华[1] 杨春[1] 张喜凤[1] 李英华[1] 

机构地区：[1]聊城市第二人民医院儿科,山东聊城252600

出　　处：《实用儿科临床杂志》2007年第20期1554-1555,1559,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨亚临床甲状腺功能减退症(亚临床甲减)患儿病因及甲状腺素干预治疗对其转归的影响。方法对200例亚临床甲减患儿测定血清甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TMAb);并予甲状腺彩色多普勒超声检查、甲状腺穿刺细胞学检查、甲状腺摄131I率测定。按病因随机分为治疗组和对照组各100例。治疗组予甲状腺素(优甲乐)25～75μg/d,治疗剂量以游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、高敏促甲状腺激素(sTSH)正常为标准,1a后停用甲状腺素,停药0.5a复查甲状腺功能。结果亚临床甲减儿童病因中,桥本甲状腺炎占56%,单纯性甲状腺肿占26%,抗甲状腺药物占6%,甲减甲状腺素替代治疗不足占5%,原因不明占7%。儿童亚临床甲减予甲状腺素替代治疗后使甲状腺功能保持正常1a,停用甲状腺素后0.5a仍能使大部分患儿甲状腺功能保持正常。治疗与对照组治愈率、有效率差异有显著性(t=20.2,3.2Pa<0.01)。结论儿童亚临床甲减病因以桥本甲状腺炎为主;甲状腺素干预治疗可改善其预后。Objective To explore the causes of subclinical hypothyrodism in children and the effects of the interventional therapy with thyroixine on the course of it. Methods Two hundreds children with subclinical hypothyroidism were measured for thyroglobulin antibody （ TGAb）, thyroid mierosomal antibody （TMAb） in the blood serum, examined by eolord Dopplor ultrasonic, examined by fine needle aspiraton cytology of the throid and measured the rate of ^131I ＇absorbed by thyroid in order to find out the causes of the disease. Two hundreds cases were randomly divided into two groups on the base of the cause of diseases,treatment group 100 cases and control group 100 cases. The treatment group were treated by throxine 25 -75 μg/d and the therapeutic dosage were chosen with the normal value of free triiodothyronine（ FF3 ） ,free thyroxine （ FT4 ） and high sensitive thyrotropin （sTSH） in the blood serum . After one year thyroxine therapy were stopped. Thyroid function was examined 6 months later after stopping the thyroxine. Results Among all of the causes of subclinical hypothyroidism in children, Hasgumoto＇s thyroiditis accounts for 56%, simple goiter accounts for 26%, antithyroid drug accounts for 6% ,the lack of thyroxine substitution therapy on the hypothyroidism accounts for 5% and undefined causes accounts for 7% . The thyroid function could keep normal for 1 year with an alternative therapy with thyroxine on subclinical hypothyroidism in children. Half a year later alter stopping thyroxine, the thyroid function turned normal in most of the children. There were obvious differences in the ratio of cure and the ratio of effectiveness between treatment group and control group （t = 20. 2,3.2 Pa 〈 0.01 ）. Conclusions In all of the causes of subclinical hypothyroidism in children, Hasgumoto＇s thyroiditis is the main cause. Interventional treatment on it with thyroxine can improve its prognosis.

关 键 词：儿童 亚临床 甲状腺功能减退症 甲状腺素 干预治疗 预后 

分 类 号：R725.8[医药卫生—儿科]