珠海市10年先天性甲状腺功能减低症的治疗及远期随访  

The Long-term Follow-up and Treatment of Congenital Hypothyroidism During 10 Years in Zhuhai

作　　者：梁晓红[1] 程黎[1] 杨海虹[1] 

机构地区：[1]珠海市妇幼保健院儿童保健科,广东珠海519000

出　　处：《临床医学工程》2014年第3期379-381,共3页Clinical Medicine & Engineering

摘　　要：目的了解珠海市先天性甲状腺功能减低症(CH)的发病率、经筛查诊治的CH患儿远期预后。方法我院新生儿疾病筛查中心于2003年1月至2012年12月按卫生部《新生儿疾病筛查技术规范》共对珠海市177 522名新生儿进行了先天性甲状腺功能减低症筛查,确诊CH患儿89例。有80例在本院儿童保健科治疗随访,平均18.5天开始给予左甲状腺素钠规范治疗。定期复查静脉血游离三碘甲状腺素(FT3),游离甲状腺素(FT4)及促甲状腺素(TSH)水平,根据甲状腺功能监测结果进行个体化药量调整。监测患儿体格发育如身高、体质量,用WHO推荐标准进行体格发育评价。4岁以下用盖泽尔发育量表,4岁以上用韦氏智力量表进行智力发育评价。结果珠海市10年间的CH发病率为1∶1 995。有59例CH患儿体格发育随访至2周岁,无1例发生生长迟缓,2岁时身高达中等及以上水平占91.5%,体质量达中等及以上水平占71.2%。有49例CH患儿做了智力发育测评,取最近一次智测资料统计,CH患儿总智商得分正常者占85.7%(42/49),临界水平占8.2%(4/49),发育迟缓占6.1%(3/49)。两变量两两相关分析显示,治疗前的FT3、FT4水平与总智商得分呈线性正相关,治疗前的TSH水平、开始治疗的天数、需要激素替代维持的时间与总智商得分呈线性负相关。结论珠海市经筛查诊治的CH患儿远期体格和智能发育预后大多良好。CH病情严重程度、治疗环节因素对患儿远期智力预后会有影响,要注意治疗随访环节质量管理。为减少CH的发生,应开展本地区先天性甲状腺功能减低症危险因素研究。Objective To comprehend the morbidity of congenital hypothyroidism （CH） in Zhuhai and the long-term prognosis of children with CH diagnozed and treated via screening. Methods According to Neonatal Screening Technical Specifications by the Ministry of Health, 177 522 newborns were screened in the neonatal disease screening center of our hospital for congenital hypothyroidism from January 2003 to December 2012, in whom 89 children were diagnozed with CH. 80 children were treated and followed-up in child health care department in our hospital, receiving levothyroxine sodium standard treatment beginning at 18.5 days averagely, periodically reviewing venous blood free three iodine thyroxin （FT3）, free thyroxin （FT4）, and thyroid stimulating hormone （TSH）. Individualized dose was adjusted on the basis of thyroid fimction monitoring results. Children＇s physical development such as height, weight was monitored and evaluated with WHO recommending criteria. Mental development was evaluated with Geisel Developmental Scale for children under the age of 4, with Wechsler Intelligence Scale above the age of 4. Results In 10 years, CH incidence rate was 1 ： 1 995 in Zhuhai. 59 CH children were followed up to 2 years old, with no case of growth retardation. Among them, 91.5% children＇s height reached or exceeded medium level, 71.2% children＇s weight reached or exceeded medium level. 49 CH children proceeded with mental development assessment, the latest intelligence test statistics showed that 85.7% CH children got total normal IQ scores （42/49）, 8.2% children reached critical level （4/49）, and 6.1% children had development delays （3/49）. Two variables correlation analysis indicated that FT3, FT4 before treatment had positive linear correlation with total IQ, TSH level before treatment, days of starting treatment, and the time to maintain hormone replacement had negative correlation with total IQ. Conclusions Most CH children diagnozed and treated via screening in Zhuhai have good long-term pro

关 键 词：先天性甲状腺功能低下症 治疗 随访 预后 

分 类 号：R725.8[医药卫生—儿科]