左旋甲状腺素钠治疗先天性甲状腺功能减退症的初始剂量研究  

Optimal initial dose of levothyroxine for treatment of congenital hypothyroidism

作　　者：陈肖肖[1] 施玉华[1] 曹丽佩[1] 周雪莲[1] 杨茹莱[1] 毛华庆[1] 赵正言[1] 

机构地区：[1]浙江大学医学院附属儿童医院筛查科,杭州310003

出　　处：《中华内分泌代谢杂志》2010年第4期273-277,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：基金项目：浙江省科技厅科研基金重点项目（G20020584）

摘　　要：目的探讨先天性甲状腺功能减退症（CH）左旋甲状腺素钠（L-T4）替代治疗的初始剂量。方法对筛查确诊的CH患儿分为A（n=36）、B（n=51）、C（n=40）3组，分别采用L—T410、8和6μg·kg^-1·d^-13种不同的初始剂量治疗，分别在治疗后第2周、4～6周、8～12周复查血清TSH、T4和FT4水平，根据结果进行L-T4剂量的个体化调整。12周后每3个月复查1次，随访2年。期间定期进行患儿体格发育评价，甲状腺超声检查、骨龄检测和智能发育测定。结果127例患儿治疗2周，（1）TSH水平，A、B组迅速下降至正常范同[（1．3±1．5）mU／L和（3．7±5．6）mU／L]，两组间差异无统计学意义（P=0．28），A组中8例（22．2％）TSH下降到0．5mU／L以下；C组TSH均未降至正常[（11．4±16．5）mU／L]，与A、B组比较有显著性差异（P〈0．01），其中10例（25．0％）TSH〉10mU／L，平均值为（34．0±19．2）mU／L。（2）T4、FT4水平迅速提高，A组有9例（25．0％）T4〉250nmol／L；11例（30．6％）FT4〉45pmol／L，达到正常值高限的1．5倍，并出现高甲状腺素血症，13例（36．1％）患儿分别表现腹泻、烦躁、多汗、哭吵不安等甲状腺功能亢进的临床症状。治疗12周后3组间TSH、T4和FT4水平无显著差异，L—T4剂量也无显著差异。治疗随访2年，127例身高、体重均达到相应年龄的正常范围（x±s）；腕部骨龄成熟程度达到相应年龄，3组无显著性差异；智力发育达到正常水平，3组间差异无统计学意义（均P〉0．05）。结论L—T4初始剂量（8．0±0．5）μg·kg^-1·d^-1是我国先天性甲状腺功能减退症初始治疗比较安全、合理、有效的剂量。CH替代治疗时，L-T4剂量必须个体化，保持甲状腺功能与其年龄相匹配的水平，应能保证其体格和智能的正常发育。Objective The purpose of this study was to investigate the optimal initial dose of levothyroxine （L-T4） for treatment of congenital hypothyroidism （CH）. Methods One hundred and twenty-seven CH infants were assigned to A（ n = 36） , B（ n = 51 ） , and C （n = 40） groups. Different initial doses were given to the patients, 10 μg· kg^-1 ·d^-1 forAgroup, 8 μg·kg^-1· d^-1 for B group and 6 μg·kg^-1· d^-1 for C group. BloodTSH, T4 and FT4 levels were determined at 2 weeks, 4-6 weeks and 8-12 weeks after medication. L-T4 dose was adjusted individually according to the blood hormone levels. Thyroid hormone levels were rechecked every three months after 12 weeks of medication. All the patients were followed up for 2 years, with regular assessment of growth, development, and thyroid ultrasonography. Results After 2 weeks＇ medication, TSH levels in both A and B groups were reduced to reference range [ （1.3±1.5） mU/L and （3.7±5.6） mU/L]. No difference was found between the 2 groups （P=0.28）. Eight patients （22.2%） in the A group had a reduced TSH level to less than 0.5 mU/L. TSH level in the C group remained abnormal [ （11.4±16.5）mU/L] and significant difference was observed when compared with those in the B and C groups（P〈0.01 ）. 10 patients in the C group had a TSH level more than 10 mU/L [ （34.0±19.2）mU/L]. T4 and FT4 levels in all the three groups increased markedly. 9 patients （25.0%） in the A group had T4 level more than 250 nmol/L, and 11 patients （30. 6%） showed hyperthyroxinemia with FT4 level more than 45 pmoL/L （ 1. 5 folds of upper limit of the reference range）. 13 patients in the A group showed clinical symptoms of hyperthyroidism such as diarrhea, irritability, sweating, cry, and so on. After 12 weeks medication, no significant difference was found in blood TSH, T4, and FT4 levels among the 3 groups. Also no difference was obsen＇ed in adjusted L-T4 dosages among the 3 groups. After 2-year follow-up, clinical examinations including heigh

关 键 词：左旋甲状腺素钠 治疗 先天性甲状腺功能减退症 初始剂量 

分 类 号：R581.2[医药卫生—内分泌]