先天性甲状腺功能减低症不同转归的早期预测因子探讨  

Early predictors for outcomes of congenital hypothyroidism in neonates

作　　者：范惠霞 高苗苗 阎亚琼[1] 李晓禹 Fan Huixia;Gao Miaomiao;Yan Yaqiong;Li Xiaoyu(Shanxi Women and Children Health Hospital,Taiyuan 030013,China;Basic medical school of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西省妇幼保健院,太原030013 [2]山西医科大学基础医学院,太原030001

出　　处：《中华全科医师杂志》2020年第12期1141-1146,共6页Chinese Journal of General Practitioners

基　　金：山西省科技厅软科学研究项目(2018041035-2)。

摘　　要：目的探讨能够对不同转归先天性甲状腺功能减低症(CH)患儿进行早期区分的预测因子。方法以2009年10月至2014年10月确诊并在山西省新生儿疾病筛查中心经左旋甲状腺素钠(L-T4)治疗随访2~3年,且停药再评估后继续随访1年以上者为研究对象,根据随访结果区分永久性CH(PCH)与暂时性CH(TCH),并对两组患儿的临床基本情况及随访期间的L-T4给药剂量进行对比,寻找早期预测因子。结果PCH与TCH患儿在初筛促甲状腺激素(TSH)水平[127.0(83.7,175.4)比55.8(22.1,102.5)μIU/ml]、初始给药日龄[26.0(20.5,34.5)比31.0(24.0,37.5)d]、TSH恢复日龄[52.0(33.0,71.5)比36.0(32.0,41.5)d]、甲状腺超声正常比例[18.3%(11/60)比94.0%(78/83)]等方面的差异具有统计学意义(Z=6.059、2.957、3.596,χ^2=84.784;P<0.05)。患儿的初筛TSH水平(最佳临界值:71.29μIU/ml,曲线下面积=0.777;灵敏度0.833;特异度0.623)和确诊后第7个月的L-T4给药剂量(最佳临界值:24.4μg/d)可用于对PCH与TCH患儿进行早期区分。结论初筛TSH水平和随访期间L-T4给药剂量对早期区分PCH与TCH具有预测意义。Objective To explore early predictive factors for outcomes of congenital hypothyroidism(CH)in neonates.Methods A total of 242 neonates diagnosed as CH in Shanxi Provincial Newborn Disease Screening Center from October 2009 to October 2014 were enrolled in the study.All CH children were treated with levothyroxine sodium(L-T4)for 2-3 years and continued to follow up for more than 1 year after drug withdrawal.Seventy two cases dropped out during the follow-up;among 170 patients entering the final analysis,there were 61 cases of permanent congenital hypothyroidism(PCH group)and 109 cases of transient congenital hypothyroidism(TCH group).The clinical data and the L-T4 dose during follow-up period were compared between two groups;and the predicting factors of clinical outcomes were analyzed.Results There were significant differences in baseline thyroid stimulating hormone(TSH)level[127.0(83.7,175.4)μIU/ml vs.55.8(22.1,102.5)μIU/ml],initial treatment timing[26.0(20.5,34.5)d vs.31.0(24.0,37.5)d],time required for TSH to return to normal[52.0(33.0,71.5)d vs.36.0(32.0,41.5)d],and thyroid ultrasound results[18.3%(11/60)vs.94.0%(78/83)]between PCH group and TCH group.The initial screening TSH levels in children(optimal cut-off:71.29μIU/ml)and L-T4 dose at 7 months after diagnosis(optimal cut-off:24.4μg/d)can be used for early differentiation between children with PCH and TCH.Conclusion The initial TSH screening levels and the dose of L-T4 during the follow-up period have predictive value for early differentiation of PCH and TCH in children.

关 键 词：先天性甲状腺功能减低症 促甲状腺激素 预测 不同转归 

分 类 号：R735.9[医药卫生—肿瘤] R576[医药卫生—临床医学]