儿童桥本甲状腺炎55例的临床特征  

Clinical Features of 55 Children with Hashimoto′s Thyroiditis

作　　者：唐诗[1] 辛颖[1] 

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004

出　　处：《实用儿科临床杂志》2012年第8期581-584,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的提高对儿童桥本甲状腺炎(HT)的认识,达到早期诊断及治疗的目的,进而改善其预后。方法本研究对55例HT患儿的临床资料进行回顾性分析,包括临床症状、体征、辅助检查、并发症及治疗方案。辅助检查方面,患儿均完善游离甲状腺素(FT4)、游离三碘甲状腺氨酸(FT3)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺彩超检查,患儿行血常规(45例)、肝功能(35例)、血脂系列(29例)、下丘脑垂体增强磁共振(9例)等检查。结果 55例患儿中,男10例,女45例。临床表现复杂多样。其中发现甲状腺大38例、身材矮小15例、乏力20例,另有患儿存在纳差、便秘、学习成绩差、贫血等改变。34例在首次就诊时处于甲状腺功能减低(甲低)期,12例处于亚临床甲低期,7例处于甲状腺功能亢进期,2例处于甲状腺功能正常期。甲状腺彩超的典型改变是甲状腺弥散性改变,轻中度增大,峡部增厚明显,甲状腺回声粗糙、不均匀、减弱,8例呈网格样改变,9例内有结节。患儿心脏(11例)、垂体(5例)、肌肉(2例)、肝功能(2例)、血脂(18例)等存在异常。结论 HT患儿可表现出多种多样的症状和体征,多以颈部增粗、身材矮小为主诉就诊,就诊时大部分患儿处于甲低期,临床医师应详细询问患儿病史,仔细查体,完善辅助检查,做到早期诊断及治疗以改善预后。Objective To enhance the pediatrician′s understanding of childhood Hashimoto′s thyroiditis（HT）,facilitate early diagnosis and treatment,and thereby improve the prognosis. Methods In this study,clinical data of the 55 patients were analyzed retrospectively,including their clinical symptoms,physical signs and complications,auxiliary examinations undertaken and their corresponding treatments.Concer-ning auxiliary examinations,all these patients had received examinations of free tetraiodothyronine（FT4）,free triiodothyronine（FT3）,thyroid stimulating hormone（TSH）,thyroid peroxidase antibody（TPOAb）,thyroglobulin antibody（TGAb） and thyroid ultrasonography.In addition,examinations like blood routine test（45 cases）,liver function test（35 cases）,lipid series test（29 cases）,and hypothalamic and pituitary enhancement MRI（9 cases）,et al.were carried out on some patients. Results Among all the 55 patients,10 cases were male and 45 cases were female,and their clinical manifestations were diverse and complex.Thirty-eight patients with thyromegaly,15 cases with short stature,20 cases with fatigue,and some patients with the change of poor appetite,constipation,poor performance in school,anemia.In regard to first diagnosis,34 patients were found with hypothyroidism,12 cases with subclinical hypothyroidism,7 cases with hyperthyroidism,and 2 cases with euthyroidism.Typical changes revealed from color Doppler ultrasound examination for thyroid were reflected in the aspects as follow：diffused changes and mild-moderate enlargement to the gland,apparent thickening of the isthmus,thyroid echo being rough,uneven and weakened,and some even change in a grid-like form with nodules inside.Through the examination,abnormalities of some children,involving the pituitary（5 cases）,heart（11 cases）,muscle（2 cases）,liver function（2 cases）,and blood lipid（18 cases）,were identified. Conclusions Diverse symptoms and signs may occur to patients with HT.Most patients are referred to Shengjing

关 键 词：桥本甲状腺炎 临床特征 儿童 

分 类 号：R725.8[医药卫生—儿科]