成都市710603例新生儿先天性甲状腺功能减低症筛查结果及患儿治疗情况和智力发育影响因素  

Screening results of CH in 710603 neonates of Chengdu and treatment of confirmed cases,and influencing factors for intellectual development

作　　者：姜舟 刘奕君 李晓丽 王梅 JIANG Zhou;LIU Yijun;LI Xiaoli;WANG Mei(Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院成都市妇女儿童中心医院,四川成都611731

出　　处：《山东医药》2020年第36期7-11,共5页Shandong Medical Journal

基　　金：四川省科技计划资助项目(2019JDPT0034)。

摘　　要：目的分析成都市710603例新生儿先天性甲状腺功能减低症(CH)筛查结果及患儿治疗情况和智力发育影响因素。方法采用时间分辨免疫荧光法检测710603例新生儿足跟滤纸干血片促甲状腺激素(TSH),初筛CH阳性者召回复查静脉血TSH、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)进一步确诊。对确诊的215例CH患儿进行左旋甲状腺素片替代治疗,定期随访患儿身高、体质量,进行盖泽尔婴幼儿发展量表(GESELL)评估患儿智力。采用单因素分析法和多因素Logistic回归分析法分析CH患儿智力发育的影响因素。结果710603例新生儿中,初筛CH阳性4234例(0.59%),召回复查4035例(95.30%),确诊CH 253例(0.03%)。对215例CH患儿进行随访,其中147例(68.37%)患儿在1月龄内开始口服左旋甲状腺素钠治疗,58例(26.98%)患儿在2~3月龄开始治疗,10例(4.65%)在3月龄后开始治疗,174例(80.93%)患儿FT4在14 d以内恢复正常,130例(60.47%)患儿TSH在14 d^1个月恢复正常;170例(79.10%)CH患儿身高、186例(86.52%)CH患儿体质量达同龄儿童正常范围,与同龄正常儿童相比无统计学差异(P>0.05);207例(98.09%)患儿GESELL测试DQ平均分>70分,与正常儿童[209例(99.52%)]相比无统计学差异(P>0.05);140例(66.67%)患儿DQ平均分>85分,与正常儿童[165例(78.57%)]相比有统计学差异(P<0.05)。CH患儿智力发育影响因素为甲状腺发育情况、父亲学历、治疗依从性、FT4维持水平(P均<0.05)。结论2016—2018年共对710603例新生儿进行筛查,初筛CH阳性4234例,确诊CH 253例;对确诊CH患儿进行规范治疗和管理后,患儿体格发育及智力发育基本达到正常儿童水平;甲状腺彩超情况、父亲学历、治疗依从性、FT4维持水平是CH患儿智力发育的影响因素。Objective To analyze the screening results of congenital hypothyroidism(CH)in 710603 neonates in Chengdu and the treatment of confirmed cases,and to determine the influencing factors for their intellectual development.Methods The concentration of thyroid stimulating hormone(TSH)in the heel dried blood filter paper of 710603 neonates was determined by time-resolved immunofluorescence.Neonates with positive results were recalled for reexamination of venous blood TSH,free triiodothyronine(FT3)and free thyroxine(FT4)to confirm the diagnosis.A total of 215 children were treated with levothyroxine replacement tablets.Patients were followed up regularly for height and body mass,meanwhile their intelligence was measured by Gesell Developmental Schedules(GESELL).Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors for CH children's intellectual development.Results Among 710603 neonates,4234(0.59%)were positive at initial screening,4035 cases(95.30%)were recalled,and 253 cases(0.03%)were diagnosed with CH.The 215 patients were followed up,of who 205(95.35%)began treatment within 3 months of age.FT4 in 174 cases(80.93%)returned to normal within 14 days,and TSH in 130 ca-ses(60.47%)returned to normal within 14 d-1 month.The height of 170 cases(79.10%)and body mass of 186 cases(86.52%)reached the normal range of children at their age.Compared with children at the same age,the differences were not statistically significant(both P>0.05).The GESELL DQ of 207(98.09%)CH children had an average score of>70,and there was no statistical difference compared with that in 209 children of the normal group(99.52%)(P>0.05).The average DQ score of 140(66.67%)CH children was>85,which was statistically different from that of 165 cases(78.57%)in the normal group(P<0.05).The factors associated with CH children's intellectual development were thyroid development,father's educational background and treatment compliance and FT4 level(all P<0.05).Conclusions From 2016 to 2018,a total of 7106

关 键 词：先天性甲状腺功能减低症 左旋甲状腺素片 智力发育 盖泽尔婴幼儿发展量表 

分 类 号：R581[医药卫生—内分泌]