先天性甲状腺功能减低症初始治疗结果分析  

Analysis of the initial treatment results of congenital hypothyroidism

作　　者：杨海河[1] 张玉敏[1] 裘蕾[1] 孔元原[1] 赵娟[1] 

机构地区：[1]首都医科大学附属北京妇产医院北京市新生儿疾病筛查中心,北京100026

出　　处：《中国儿童保健杂志》2010年第8期660-663,共4页Chinese Journal of Child Health Care

摘　　要：【目的】通过对先天性甲状腺功能减低症(congenital hypothyroidism,CH)初始治疗后甲功恢复情况及其影响因素的分析,探讨不同病情程度的适宜初始甲状腺激素用量。【方法】以北京市2001—2009年经新生儿疾病筛查程序诊治的CH患儿为研究对象,采用促甲状腺激素作为代表参数,对治疗后1月的甲功结果进行评价并分析其相关因素。【结果】初始治疗1月后,308例CH中甲功低下52例(16.88%)、正常219例(71.1%)、继发甲亢37例(12.01%);3组病例T4及FT4呈现特殊的变化特点,均高于常规诊断范围。相关因素分析显示:在标准剂量条件下,不同病情程度CH的初治结果差异存在统计学意义:T4>20 nmol/L组治疗后甲功正常率(89.58%)明显高于T4≤20 nmol/L组(59.49%);而后者治疗不充分发生率(40.51%)显著高于前者(10.42%)。【结论】CH治疗初始阶段T4应维持在较高水平;不同病情程度的CH应选用不同的初始剂量方案。【Objective】 To find out the appropriate initial levothyroxine（L-T4） dose in different degree congenital hypothyroidism（CH） by analyzing the initial treatment results and its affecting factors. 【Methods】 The objects were neonates with CH diagnosed by neonatal screening program from 2001 to 2009 in Beijing.The effects were evaluated by the serum TSH level after 1 month of L-T4 treatment.It＇s affecting factors were analyzed. 【Results】 Among 308 neonates with CH received L-T4 treatment for 1 month,52（16.88%） of them remained hypothyroidism,219（71.1%） cases had normal TSH level,and 37（12.01%） cases had secondary hyperthyroidism.The T4 and FT4 level in all these three groups were higher than the diagnosis level.Corelationship analysis showed that the results of initial treatment with standard dose were different significantly among groups.The rate of normal thyroid function after treatment in T4 20 nmol/L group（89.58%） was higher than those in T4≤20 nmol/L（59.49%）.The inadequate treatment rate（40.51%） in later group was higher than those in former group（10.42%）. 【Conclusions】 At the beginning of CH treatment,the serum T4 should be maintained at a higher level.The iniatial L-T4 dose should be different in different degree of CH.

关 键 词：先天性甲状腺功能减低症 左旋甲状腺素 剂量 

分 类 号：R725.8[医药卫生—儿科]