中山市先天性甲状腺功能减低症筛查及治疗效果分析  

Analysis of screening and therapeutic effect of congenital hypothyroidism in Zhongshan

作　　者：黄连红[1,2] 上官予梅[3] 付四毛[1,2] 刘玉玲[1,2] 欧俊斌[1,2] 徐康[1,2] 张翠梅[3] 

机构地区：[1]南方医科大学第三临床医学院 [2]南方医科大学附属中山博爱医院儿科,广东中山528403 [3]中山市博爱医院儿童保健科,广东中山528403

出　　处：《临床儿科杂志》2014年第9期876-880,共5页Journal of Clinical Pediatrics

基　　金：广东省社会发展领域科技计划项目(No.20120318084)

摘　　要：目的总结先天性甲状腺功能减低症(CH)筛查状况,并分析替代治疗疗效。方法采用时间分辨荧光免疫法测定新生儿滤纸干血片标本的促甲状腺激素(TSH)水平,阳性者召回并采用化学发光法检测静脉血TSH、游离甲状腺素以确诊。选取经确诊CH并规范治疗2年的永久性CH患儿54例(CH组)及正常健康儿童120例(对照组),两组均长期监测体格发育,并于6月龄、24月龄时采用Gesell婴幼儿发育量表及儿童气质量表分别评估神经运动发育水平及气质特征。结果共筛查新生儿285242例,确诊140例,CH发病率1/2037。CH组及对照组的年龄别身高Z评分(LAZ)及年龄别体质量Z评分(WAZ)差异无统计学意义(P均>0.05);6月龄、24月龄时CH组Gesell总发育商与对照组差异无统计学意义(P均>0.05),但大运动发育商均落后于对照组,差异有统计学意义(P均<0.05);6月龄、24月龄时,CH组和对照组气质类型的分布差异有统计学意义(P均<0.05);相比对照组,CH组中难养型及中间偏难养型的比例较高。CH组与对照组在活动水平、适应性、反应强度及坚持性四个维度的得分差异有统计学意义(P均<0.05)。结论 CH患儿经早期替代治疗后体格生长及神经运动发育基本正常,但尚需关注其心理行为问题。Objectives To summarize screening and therapeutic effects of congenital hypothyroidism （CH） in Zhongshan. Methods The thyroid stimulating hormone （TSH） concentration in dried heel blood samples on iflter paper was detected using time-resolved fluorescence immunoassay. The cases of positive screening tests were called back for further examination of venous blood TSH concentration using chemiluminescence method. Fifty-four children with permanent CH treated routinely for 2 years （CH group） and 120 age-gender matched health children （control group） were recruited. The physical development （height, body weight） was monitored. The neurodevelopment and temperament type were tested using Pediatric Nneuropsychological Development Assessment and Children＇s Temperament Scale respectively at 6 and 24 months after birth. Results Two hundred eight-five thousand two hundred forty-two neonates were screened. One hundred and forty cases were confirmed and the incidence rate was 1/2037. There was no statistical difference in length-for-age z score （LAZ） and weight-for-age z score （WAZ） between CH and control group （P〉0.05）. The neurodevelopment in CH group was normal, but gross motor development was worse than that in control group （P〈0.05）. The temperament type and distribution had statistical difference between CH and control group （P〈0.05）. The percentage of the dififcult type and central dififcult type was increased in CH group as compared to control group, especially in the activity, adaptability, reaction intensity and perseverance （P〈0.05）. Conclusions The physical and neurodevelopment are nearly normal in patients with CH after early supplementation, but the psychological behavior problems need to be focused on in the process of intervention.

关 键 词：先天性甲状腺功能减低症 体格发育 神经运动发育 气质 儿童 

分 类 号：R725.8[医药卫生—儿科]