不同初始治疗时机对先天性甲状腺功能减退症患儿的治疗效果分析
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摘要
目的比较不同初始治疗时机对先天性甲状腺功能减退症(CH)患儿体格与智力发育的影响。方法以经新生儿疾病筛查确诊为CH且体格、智力评估资料完善的84例患儿为研究对象,根据不同初始治疗时机分为1月内治疗组(38例)与1～3月治疗组(46例)。分别比较两组患儿在6、12、24月3个时间点的甲状腺功能及体格、智力发育情况。结果经长期治疗后,两组患儿在6、12、24月3个月龄的促甲状腺激素、游离甲状腺素及身高、体重差异均无统计学意义(P>0.05)。此外,两组患儿在6月龄、24月龄时的5个能区评分差异也无统计学意义(P>0.05),仅在12月龄时的社交行为能区评分差异有统计学意义(P<0.05)。结论不同初始治疗时机对CH患儿的神经发育有一定影响,因此,患儿一旦确诊,应尽早治疗。
Objective To compare the effacies of different initial treatment timing on physical and mental development of children with congenital hypothyroidism(CH). Methods Eighty-four children with congenital hypothyroidism(CH) diagnosed by neonatal disease screening from October 2014 to October 2016 and with complete physical and intellectual data were enrolled in the study. According to the different initial treatment timing, they were classified into treatment group within 1 month(38 cases) and treatment group from 1 to 3 months(46 cases). The thyroid function, physical development levels and neural development were compared at 6 months, 12 months and 24 months old. Results After long-term treatment, there was no significant difference in thyroid stimulating hormone(TSH), free thyroxine(FT4), height or weight between the two groups at 6 months, 12 months, and 24 months old(P>0.05). In addition, there was no significant difference in intelligence scores between the two groups at 6 months and 24 months old(P>0.05). There was a statistically significant difference only in social behavioral scores at 12 months old(P<0.05). Conclusion Different initial treatment timing has a certain influence on the neurodevelopment of children with CH. Therefore, once the child was diagnosed, it should be treated as soon as possible.
Objective To compare the effacies of different initial treatment timing on physical and mental development of children with congenital hypothyroidism(CH). Methods Eighty-four children with congenital hypothyroidism(CH) diagnosed by neonatal disease screening from October 2014 to October 2016 and with complete physical and intellectual data were enrolled in the study. According to the different initial treatment timing, they were classified into treatment group within 1 month(38 cases) and treatment group from 1 to 3 months(46 cases). The thyroid function, physical development levels and neural development were compared at 6 months, 12 months and 24 months old. Results After long-term treatment, there was no significant difference in thyroid stimulating hormone(TSH), free thyroxine(FT4), height or weight between the two groups at 6 months, 12 months, and 24 months old(P>0.05). In addition, there was no significant difference in intelligence scores between the two groups at 6 months and 24 months old(P>0.05). There was a statistically significant difference only in social behavioral scores at 12 months old(P<0.05). Conclusion Different initial treatment timing has a certain influence on the neurodevelopment of children with CH. Therefore, once the child was diagnosed, it should be treated as soon as possible.
引文
[1] 刘先知.新生儿先天性甲状腺功能低下症的危险因素[J].实用医院临床杂志,2009,6(6):21-23.
[2] 徐要选,王明英,邸文治,等.沧州市新生儿先天性甲状腺功能减低症筛查结果分析[J].中国现代药物应用,2016,10(21):56-58.
[3] 周婧瑶,欧明才,罗晓菊,等.四川省新生儿 CH 筛查切值的探讨[J].中国妇幼健康研究,2013,5(24):638-640.
[4] 阎亚琼.山西省先天性甲状腺功能减低症流行病学特征及治疗效果分析[D].太原:山西医科大学,2016.
[5] 中华医学会儿科学分会内分泌遗传代谢组,中华预防医学会儿童保健分会新生儿疾病筛查组.先天性甲状腺功能减低症诊疗共识[J].中华儿科杂志,2011,49(6):421-424.
[6] Cranefield PF.The discovery of cretinism[J].Bull Hist Med,1962,36:489-511.
[7] Horn S,Heuer H.Thyroid hormone action during brain development:more questions than answers[J].Mol Cell Endocrinol,2010,315(1):19-26.
[8] Zoeller RT,Rovet J.Timing of Thyroid Hormone Action in the Developing Brain:Clinical Observations and Experimental Findings[J].J Neuroendocrinol,2004,16(10):809-818.
[9] 刘志兰.新生儿先天性甲状腺功能减低症探讨[J].世界最新医学信息文摘,2018,18(8):148-149.
[10] 王德承.先天性甲状腺功能减低症患儿骨龄的影响因素分析[J].泰山医学院学报,2015,36(3):346-347.
[11] Albert BB,Heather N,Derraik JG,et al.Neurodevelopmental and body composition outcomes in children with congenital hypothyroidism treated with high-dose initial replacement and close monitoring[J].Clin Endocrinol Metab,2013,98(9):3663-3670.
[12] Cattani D,Goulart PB,Cavalli VL,et al.Congenital hypothyroidism alters the oxidative status,enzyme activities and morphological parameters in the hippocampus of developing rats[J].Mol Cell Endocrinol,2013,375(1/2):14-26.
[13] 蒋群,韩连书,叶军,等.先天性甲状腺功能减退症患儿甲状腺形态学改变和治疗时机对智力发育的影响[J].中华内分泌代谢杂志,2007,23(6):498-500.
[14] 陆艳红,刘晓瑛,宋媛.早期治疗对先天性甲状腺功能减低症患儿智力及体格发育的影响[J].中国当代儿科杂志,2012,14(6):418-421.
[15] 李春华,黄丽琼,黄海忠.不同时机治疗先天性甲状腺功能减低症对智力和体格发育的影响[J].海南医学,2011,22(3):104-105.
[16] Nili S,Ghaderi E,Ghotbi N,et al.Comparison of IQ between Patients with Treated Congenital Hypothyroidism and Healthy Children in the Kurdish Population-A Historical Cohort[J].Acta Endocrinologica,2015,11(3):299-305.
[17] Rose SR,Brown RS.Update of newborn screening and therapy for congenital hypothyroidism[J].Pediatrics,2006,117(6):2290-2303.
[18] Mirabella G,Feig D,Astzalos E,et al.The effect of abnormal intrauterine thyroid hormone economies on infant cognitive abilities[J].J Pediatr Endocrinol Metab,2000,13(2):191-194.
[19] 王秀云,陈远秀,彭酒,等.先天性甲状腺功能减退症患儿神经精神发育影响因素分析[J].中国实用神经疾病杂志,2015,18(10):63-65.
[20] 杨景晖,张靖辉,章印红,等.云南省部分地区先天性甲状腺功能减低症治疗效果分析[J].中国当代儿科杂志,2017,19(7):741-747.
[21] 姜雪锦,王晓蓉,王菁,等.先天性甲状腺功能低下症疗效评估及相关因素分析[J].中国儿童保健杂志,2013,21(4):342-344.
[22] 郑洁丽,邹新英,张小兰,等.先天性甲状腺功能减低症最佳治疗时机选择[J].临床医学工程,2015,22(12):1625-1627.
[23] Fu C,Luo S,Li Y,et al.The incidence of congenital hypothyroidism (CH) in Guangxi,China and the predictors of permanent and transient CH[J].Endocr Connect,2017,6(8):926-934.
[24] Salerno M,Martino LD,Cerbone M.Neurodevelopmental Outcomes in Children with Congenital Hypothyroidism//Thyroid Diseases in Childhood[M].New York:Springer International Publishing,2015:119-128.
[25] 赵正言.先天性甲状腺功能减低症[J].中华医学信息导报,2014,29(17):17.
[2] 徐要选,王明英,邸文治,等.沧州市新生儿先天性甲状腺功能减低症筛查结果分析[J].中国现代药物应用,2016,10(21):56-58.
[3] 周婧瑶,欧明才,罗晓菊,等.四川省新生儿 CH 筛查切值的探讨[J].中国妇幼健康研究,2013,5(24):638-640.
[4] 阎亚琼.山西省先天性甲状腺功能减低症流行病学特征及治疗效果分析[D].太原:山西医科大学,2016.
[5] 中华医学会儿科学分会内分泌遗传代谢组,中华预防医学会儿童保健分会新生儿疾病筛查组.先天性甲状腺功能减低症诊疗共识[J].中华儿科杂志,2011,49(6):421-424.
[6] Cranefield PF.The discovery of cretinism[J].Bull Hist Med,1962,36:489-511.
[7] Horn S,Heuer H.Thyroid hormone action during brain development:more questions than answers[J].Mol Cell Endocrinol,2010,315(1):19-26.
[8] Zoeller RT,Rovet J.Timing of Thyroid Hormone Action in the Developing Brain:Clinical Observations and Experimental Findings[J].J Neuroendocrinol,2004,16(10):809-818.
[9] 刘志兰.新生儿先天性甲状腺功能减低症探讨[J].世界最新医学信息文摘,2018,18(8):148-149.
[10] 王德承.先天性甲状腺功能减低症患儿骨龄的影响因素分析[J].泰山医学院学报,2015,36(3):346-347.
[11] Albert BB,Heather N,Derraik JG,et al.Neurodevelopmental and body composition outcomes in children with congenital hypothyroidism treated with high-dose initial replacement and close monitoring[J].Clin Endocrinol Metab,2013,98(9):3663-3670.
[12] Cattani D,Goulart PB,Cavalli VL,et al.Congenital hypothyroidism alters the oxidative status,enzyme activities and morphological parameters in the hippocampus of developing rats[J].Mol Cell Endocrinol,2013,375(1/2):14-26.
[13] 蒋群,韩连书,叶军,等.先天性甲状腺功能减退症患儿甲状腺形态学改变和治疗时机对智力发育的影响[J].中华内分泌代谢杂志,2007,23(6):498-500.
[14] 陆艳红,刘晓瑛,宋媛.早期治疗对先天性甲状腺功能减低症患儿智力及体格发育的影响[J].中国当代儿科杂志,2012,14(6):418-421.
[15] 李春华,黄丽琼,黄海忠.不同时机治疗先天性甲状腺功能减低症对智力和体格发育的影响[J].海南医学,2011,22(3):104-105.
[16] Nili S,Ghaderi E,Ghotbi N,et al.Comparison of IQ between Patients with Treated Congenital Hypothyroidism and Healthy Children in the Kurdish Population-A Historical Cohort[J].Acta Endocrinologica,2015,11(3):299-305.
[17] Rose SR,Brown RS.Update of newborn screening and therapy for congenital hypothyroidism[J].Pediatrics,2006,117(6):2290-2303.
[18] Mirabella G,Feig D,Astzalos E,et al.The effect of abnormal intrauterine thyroid hormone economies on infant cognitive abilities[J].J Pediatr Endocrinol Metab,2000,13(2):191-194.
[19] 王秀云,陈远秀,彭酒,等.先天性甲状腺功能减退症患儿神经精神发育影响因素分析[J].中国实用神经疾病杂志,2015,18(10):63-65.
[20] 杨景晖,张靖辉,章印红,等.云南省部分地区先天性甲状腺功能减低症治疗效果分析[J].中国当代儿科杂志,2017,19(7):741-747.
[21] 姜雪锦,王晓蓉,王菁,等.先天性甲状腺功能低下症疗效评估及相关因素分析[J].中国儿童保健杂志,2013,21(4):342-344.
[22] 郑洁丽,邹新英,张小兰,等.先天性甲状腺功能减低症最佳治疗时机选择[J].临床医学工程,2015,22(12):1625-1627.
[23] Fu C,Luo S,Li Y,et al.The incidence of congenital hypothyroidism (CH) in Guangxi,China and the predictors of permanent and transient CH[J].Endocr Connect,2017,6(8):926-934.
[24] Salerno M,Martino LD,Cerbone M.Neurodevelopmental Outcomes in Children with Congenital Hypothyroidism//Thyroid Diseases in Childhood[M].New York:Springer International Publishing,2015:119-128.
[25] 赵正言.先天性甲状腺功能减低症[J].中华医学信息导报,2014,29(17):17.