甲状腺素治疗新生儿高促甲状腺激素血症的效果及其预后分析

刘丽芳 张翠平 王丽云

【摘要】 目的：探討甲状腺素治疗新生儿高促甲状腺激素血症（HT）的疗效，并分析患儿预后。方法：选取本院收治的120例HT新生儿为研究对象。依据医师建议并结合患儿家属意愿将其分为治疗组（n=78）和未治疗组（n=42）。治疗组口服小剂量的左甲状腺素钠片，未治疗组不予服药治疗。比较两组治疗前后的甲状腺素水平（TSH和FT4）以及身高、体重、智力发育水平等预后指标。结果：出生后6个月，两组TSH均低于出生时，FT4高于出生时，且治疗组FT4高于未治疗组，差异均有统计学意义（P<0.05），两组TSH水平比较，差异无统计学意义（P>0.05）;出生后随访1年，两组身高、体重比较，差异均无统计学意义（P>0.05），但治疗组智力发育水平高于未治疗组（P<0.05），且未治疗组发生甲减或甲亢发生率为14.29%，高于治疗组2.56%（P<0.05），其余预后均良好。结论：临床工作中可依据HT患儿TSH水平，考虑是否给予患儿甲状腺激素治疗，且甲状腺素治疗新生儿HT的疗效明确，部分患儿未经治疗也可逐渐恢复正常，同时应积极随访、定期检查，避免过度医疗和因延误治疗时机对患儿造成的伤害。

【关键词】 高促甲状腺激素血症; 新生儿; 甲状腺素; 疗效; 预后

【Abstract】 Objective：To investigate the curative effect of thyroxine on neonatal hyperthyrotropinemia（HT），and to analyze prognosis.Method：A total of 120 HT neonates who admitted to the hospital were selected.According to the doctors advice and the wishes of the childrens families，they were divided into treatment group（n=78）and untreated group（n=42）.The treatment group was given low dose of Sodium Levothyroxine Tablets orally，while untreated group was not given medication.The thyroxine levels（TSH and FT4）before and after treatment and prognostic indicators such as height，weight and intellectual development between two groups were compared.Result：After birth 6months，the TSH in two groups were lower than those at birth，FT4 were higher than those at birth，and FT4 in treatment group was higher than that of untreated group，the differences were statistically significant（P<0.05），the TSH levels of two groups were compared，the difference was not statistically significant（P>0.05）.After 1 year of follow-up，the height and weight of two groups were compared，the differences were not statistically significant（P>0.05），but the level of intelligence development in treatment group was higher than that of untreated group（P<0.05），and the incidence of hypothyroidism or hyperthyroidism in untreated group was 14.29%，which was higher than 2.56% in treated group（P<0.05），and the remaining prognosis was good.Conclusion：In clinical work，according to TSH level of HT children，giving Thyroxine therapy to children can be considered，the curative effect of thyroxine is clear on neonatal HT，some children can gradually return to normal without treatment，active followed-up and regular examination should be conducted to avoid damage to the children caused by excessive medical care and delay treatment.

【Key words】 Hyperthyrotropinemia; Neonate; Thyroxine; Curative effect; Prognosis

First-authors address：Huizhou Maternal and Child Health Family Planning Service Center，Huizhou 516000，China

doi：10.3969/j.issn.1674-4985.2019.09.006

高促甲状腺激素血症（HT）是指血清促甲状腺素激素（TSH）增高但游离甲状腺素（FT4）水平在正常范围状态，随着新生儿疾病筛查普及，新生儿HT发生日益增高，新生儿出生后体内甲状腺激素水平出现明显而快速变化，最终为正常、持续高TSH及临床甲减多种转归形式[1]。新生儿HT在临床常见，HT新生兒最终转归结果各异，对其治疗尚缺乏统一标准[2]。一直以来甲状腺素是HT患儿重要治疗手段[3]，美国儿科学会最新先天性甲状腺功能低下（CH）治疗标准和国内专家共识指出：>2周龄患儿，当TSH水平>10 mU/L，应给予治疗，对于未接受治疗的婴儿在4周龄复查甲功时结果仍异常也应给予治疗，但对患儿服药多少、服药多久、预后如何仍无统一标准，且对此研究亦少[4-5]。对于4周内TSH维持在6～10 mU/L的婴儿治疗国内外均无统一标准，本文旨在探讨甲状腺素治疗此类HT新生儿的疗效及预后的影响。现报道如……