甲状腺激素替代治疗先天性甲状腺功能减低症患儿智力发育及影响因素分析  

Investigate of intelligence developmental level and its influencing factor in children with early-treated congenital hypothyroidism.

作　　者：傅平[1] 张立琴[1] 周继勇[1] 

机构地区：[1]青岛市妇女儿童医疗保健中心,山东青岛266011

出　　处：《中国儿童保健杂志》2008年第1期39-41,共3页Chinese Journal of Child Health Care

基　　金：青岛市科技局科研项目(05-ZN5-42)

摘　　要：【目的】分析学龄前先天性甲状腺功能减低症（congenital hypothyroidism,CH）患儿甲状腺激素替代治疗后的智力发育水平、社会适应能力及其影响因素,以寻求改善患儿生存及生活质量的最佳治疗方案。【方法】选取1996年11月-2000年11月青岛市经新生儿筛查确诊的永久性甲低患儿47例,年龄（4.92±0.79）岁;同时选取性别、年龄与之相匹配的正常儿童58例,年龄（5.17±0.66）岁,作为研究对象,采用自制的一般情况调查问卷、韦氏儿童智力量表（C-WYCSI）、婴儿-初中生社会生活能力量表以及家庭环境量表-中文版（FES-CV）进行调查分析,并采用免疫荧光法测定两组患儿甲状腺功能。【结果】①CH患儿C-WYCSI测试在语言智商（VIQ）、操作智商（PIQ）及总智商（FIQ）和所有十项分测验的得分均明显低于对照组（P〈0.01）。②CH患儿人际交往能力明显低于对照组（P〈0.01）;③CH患儿家庭的亲密度、成功性、娱乐性明显低于对照组（P〈0.01或〈0.05）;④甲状腺功能、家庭环境、育儿方式等是影响CH患儿认知发育的重要因素。【结论】甲状腺激素替代治疗后的学龄前期CH患儿智力水平虽在正常范围之内,但其智力结构、交往能力仍然存在缺陷,在进行尽早及合理治疗的前提下,应及时评估其神经心理发育及家庭养育环境情况,采取不同的心理行为治疗方案,改善其家庭养育环境,以利于其智力和心理发育。[Objective] To investigate the intelligence developmental level,social adaptability and its influencing factor in children with early-treated congenital hypothyroidism（CH） in order to improve the quality of life in CH children. [Methods] A total of 47 cases with permanent CH had been diagnosed by Qingdao Newborn Screening Center from November 1996 to November 2000,aged 4-6 years. A group of 58 healthy children, aged 5-6 years were included as a normal control. They were evaluated with self-made inventory questionnaire, Wechsler Intelligence Scale for Children Chinese Version, S-M Social Adaptability Testing Form respectively , their thyroid function were detected with immunofluorescence. [Results] （1）The mean verbal IQ （VIQ）, performance IQ （PIQ） and total scores in cognitive tests of 47 cases with permanent congenital hypothyroidism were normal, but lower than those of the controls （P〈0.01）. （2）Social adaptability of CH cases were normal, but their interpersonal communication capability was lower than that of the controls （P〈 0.01）（3）domestic level, succeed possibility and entertainment possibility were lower than that of the controls （P〈0.01 or 〈0.05）. （4）Thyroid function, home environment, child care style were the important factors to influence cognition of CH cases. [Conclusions] The early and rational treatment with thyroid hormone, nerve-mental growth and home environment evaluation are necessary in improveing the quality of life in CH children.

关 键 词：先天性甲状腺功能减低症 学龄前 智力 社会适应能力 影响因素 

分 类 号：R749.94[医药卫生—神经病学与精神病学]