基于生长发育评估和干预的儿童甲状腺B超筛查的横断面调查  

The thyroid ultrasonography screening in children based on growth development,assessment and intervention:A cross⁃sectional study

作　　者：李阳 王峥嵘[2] 郭佳运 张勇[2] 李辉[1,3] LI Yang;WANG Zhengrong;GUO Jiayun;ZHANG Yong;LI Hui(Department of Growth and Development,Capital Institute of Pediatrics,Beijing 100020,China;Department of Ultrasound,the Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Graduate school,Peking Union Medical college,BeiJing 100050,China)

机构地区：[1]首都儿科研究所生长发育研究室,北京100020 [2]首都儿科研究所附属儿童医院超声科,北京100020 [3]北京协和医学院研究生院,北京100020

出　　处：《中国循证儿科杂志》2021年第4期291-295,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：中国医学科学院医学与健康创新工程资助项目:2016-12M-1-008;北京市医院管理中心儿科学协同发展中心项目:XTZD20180403;北京市属医学科研院所公益发展改革试点项目:京医研2019-11

摘　　要：背景体检儿童中甲状腺B超发现的多囊性甲状腺疾病(PCTD)检出率较高,目前有关儿童PCTD的发生率及相关研究报道不多,且多发囊肿的随访值得重视。目的对生长发育评估需要干预的儿童行甲状腺B超筛查PCTD。设计横断面调查。方法纳入生长发育门诊主诉或为身高偏矮、或为身高生长速度减慢、或为青春期发育评估,行甲状腺功能检查FT3、FT4正常和3项抗体(Tg⁃Ab、TR⁃Ab和TPO⁃Ab)检测阴性,临床评估后需要采取药物干预且行甲状腺B超筛查的儿童,采集就诊和随访当天病历和超声结果,以B超图像观察分析指标分为正常组、PCTD组(囊肿≥4个,甲状腺自身抗体阴性,排除甲状腺实质网格状回声和甲状腺先天性畸形与异常)和其他组(甲状腺实性结节、多发囊肿伴实性结节和囊肿数量<4个)。主要结局指标B超检查儿童PCTD检出率。结果符合纳入标准的572例患儿进入本文分析,男259例,女313例,年龄3.0~17.0(9.5±2.73)岁,正常组364例,PCTD组161例(28.2%),其他组47例。正常组3~5岁年龄段和PCTD组4~5岁年龄段均为身材矮小(HtSDS<-2),其他年龄段平均身高标准差值均处于正常范围,总体体重标准差值均在正常范围,但HtSDS和WtSDS均在-2~0水平。PCTD男女童检出率分别为23.6%(61/259)和31.9%(100/313),≥7岁PCTD的检出率(>27.0%)。PCTD组甲状腺肿大11例(7.1%),正常组甲状腺肿大14例(4.6%)。PCTD组囊肿均为规则边缘,弥漫分布于双叶及峡部28例,双叶113例,右叶17例,左叶3例;双叶+左叶144例,3例≥5 mm;双叶+右叶158例,4例≥5 mm;74.5%甲状腺实质回声均匀;囊肿内可见点状强回声伴彗星尾征138例(85.7%)。正常组14例和PCTD组9例TSH>5 mIU·L^(-1)处于亚临床甲状腺功能减退。结论儿童PCTD并不少见,女童检出率高于男童,7岁以后儿童的检出率明显升高。PCTD儿童的囊肿多位于双叶,囊肿大小多<5 mm,囊内可见点状强回声,伴彗星尾征。Background The detection rate of polycystic thyroid disease(PCTD)by thyroid ultrasonography in healthy children is high,but the incidence of PCTD and related studies are few,and the other group of PCTD deserves attention.Objective Thyroid ultrasonography was performed to screen for PCTD in children who needed intervention after the assessment of growth and development.Design Cross⁃sectional survey.Methods We included the cases whose complains were relatively short stature,decreased height growth rate or puberty development assessment,with normal FT3 and FT4 and negative antibodies(Tg⁃Ab,TR⁃Ab and TPO⁃Ab),requiring drug intervention and thyroid ultrasonography after clinical evaluation.Medical records and ultrasound results on the day of visit and other were collected.According to the ultrasound image observation and analysis indicators,the patients were divided into normal group,PCTD group(≥4 thyroid cysts,negative tests for thyroid autoantibody,no evidence for thyroid diseases and abnormal thyroid structure)and other group(solid thyroid nodules,multiple cysts with solid nodules and the number of cysts less than 4).Main outcome measures Detection rate of PCTD.Results A total of 572 children met inclusion and exclusion criteria,aged from 3.0 to 17.0(9.5±2.74)years,including 259 males and 313 females.There were 364 cases in normal group,161 cases in PCTD group(28.2%),and 47 cases in follow⁃up group.HtSDS<-2 was found in the normal group at 3 to 5 years old and the PCTD group at 4 to 5 years old.WtSDS<-2 was found in the PCTD group at 5 years old.The standard deviation of height and weight in other age groups was in the normal range,but the HtSDS and WtSDS ranged from-2 to 0.The detection rate of boys and girls with PCTD was 23.6%(61/259)and 31.9%(100/313),respectively.The rate of PCTD was significantly increased(>27.0%)for 7 years or older.There were 11 cases of goiter in PCTD group(7.1%)and 14 cases of goiter in normal group(4.6%).All cysts in PCTD had regular margins and cysts were distributed diffus

关 键 词：多囊性甲状腺疾病 儿童 甲状腺 超声检查 

分 类 号：R725.8[医药卫生—儿科] R445.1[医药卫生—临床医学]