不同初始剂量左甲状腺素钠片治疗先天性甲状腺功能减退症患儿的效果、安全性及对垂体-甲状腺轴及IGF-1/IGFBP-3水平的影响  

Efficacy and Safety of Different Initial Doses of Levothyroxine Sodium Tablets in the Treatment of Children with Congenital Hypothyroidism and Its Influence on Pituitary-thyroid Axis and IGF-1/IGFBP-3

作　　者：郑美云 ZHENG Meiyun(The Second People's Hospital of Fuzhou,Jiangxi Province,Fuzhou 344000,China)

机构地区：[1]江西省抚州市第二人民医院(江西省抚州市妇幼保健院),江西抚州344000

出　　处：《中国医学创新》2023年第5期141-145,共5页Medical Innovation of China

基　　金：抚州市指导性科技计划项目(抚科计字[2021]7号-63)。

摘　　要：目的:探讨不同初始剂量左甲状腺素钠片治疗先天性甲状腺功能减退症(CH)患儿的效果、安全性及对垂体-甲状腺轴及胰岛素样生长因子-1(IGF-1)/胰岛素生长因子结合蛋白-3(IGFBP-3)水平的影响。方法:选取2020年10月-2021年10月抚州市第二人民医院收治的78例CH患儿,采用随机数字表法分为观察组和对照组,各39例,两组均采用左甲状腺素钠片治疗,观察组初始剂量为8μg/(kg·d),对照组初始剂量为6μg/(kg·d),治疗1年后,比较两组临床效果,治疗前后两组间垂体-甲状腺轴功能指标、IGF-1/IGFBP-3水平变化,身高、体重、智力发育情况,以及治疗期间不良反应发生率。结果:治疗1年后,观察组和对照组总有效率分别为94.87%和84.62%,两组间差异无统计学意义(P>0.05);两组患儿治疗后促甲状腺激素(TSH)均显著降低(P<0.05),且观察组显著低于对照组(P<0.05),血清游离甲状腺素(FT_(4))和四碘甲腺原氨酸(T_(4))均显著升高(P<0.05),且观察组均显著高于对照组(P<0.05);两组患儿治疗后IGF-1、IGFBP-3、IGF-1/IGFBP-3均显著升高(P<0.05),且观察组均显著高于对照组(P<0.05);两组患儿身高、体重、智力发育情况均显著升高(P<0.05),且观察组身高、体重、智力发育情况均显著高于对照组(P<0.05);两组间不良反应发生率差异无统计学意义(P>0.05)。结论:相较于6μg/(kg·d)初始剂量,8μg/(kg·d)初始剂量左甲状腺素钠片治疗CH效果确切,可明显改善甲状腺功能,促进身高、体重、智力发育,且安全性良好,值得推荐。Objective:To investigate the efficacy and safety of Levothyroxine Sodium Tablets at different initial doses in treating congenital hypothyroidism(CH)in children,and its influence on the pituitary-thyroid axis and the levels of insulin-like growth factor-1(IGF-1)/insulin growth factor-binding protein-3(IGFBP-3).Method:A total of78 children with CH who were treated in the Second People’s Hospital of Fuzhou from October 2020 to October2021 were selected and classified into observation group(39 cases)and control group(39 cases)by means of the random number table method.Both groups were treated with Levothyroxine Sodium Tablets,with the initial dose of 8μg/(kg·d)in observation group and 6μg/(kg·d)in control group.After 1 year of treatment,the clinical effects after treatment,as well as pituitary-thyroid axis function indicators and IGF-1/IGFBP-3,height,weight and intelligence development before and after treatment and incidence rates of adverse reactions during treatment were compared between the two groups.Result:After 1 year of treatment,the total effective rates of observation group and control group were 94.87%and 84.62%respectively,there was no significant difference between the two groups(P>0.05).Thyroid-stimulating hormone(TSH)levels were significantly decreased in both groups after treatment(P<0.05),and the observation group was significantly lower than that of the control group(P<0.05).The levels of serum free thyroxine(FT_(4))and tetraiodothyronine(T_(4))were increased significantly(P<0.05),and the observation group were significantly higher than those of the control group(P<0.05).After treatment,IGF-1,IGFBP-3 and IGF-1/IGFBP-3 of both groups were significantly enhanced(P<0.05),and the observation group were significantly higher than those of the control group(P<0.05).The height,weight and mental development were obviously improved in both groups(P<0.05),and the indicators were obviously higher in observation group than those of control group(P<0.05).There were no statistical differences in the rate of

关 键 词：左甲状腺素钠片 先天性甲状腺功能减退症 安全性 垂体-甲状腺轴 

分 类 号：R725.8[医药卫生—儿科]