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目的探讨先天性甲状腺功能低下症(CH)筛查切值、不同分类临床特征、预后及其相关因素。方法收集1999年8月-2013年4月在本院新生儿疾病筛查中心确诊并随访的CH患儿临床资料,分析CH发病率;初筛促甲状腺激素(TSH)水平;早产儿、低体重儿CH临床特征;并发症;根据随访结果区分持续性甲状腺功能低下症(PCH)与暂时性甲状腺功能低下症(TCH),比较两组的临床特征,分析预后及相关因素。结果共确诊CH 2 789例,发病率为1/1 886;确诊CH中初筛TSH值在9~10 m U/L者69例,占2.47%(69/2 789);TCH∶PCH为0.92∶1。两组间男∶女比、游离甲状腺激素(FT4)恢复正常日龄、初筛TSH值、初始用药剂量及身高、骨龄、智力发育结果差异有统计学意义(P均<0.01);PCH组中有56例(8.2%)停药观察后复用;早产儿CH117例,其中PCH占22.2%;低体重儿CH111例,PCH 34.2%;CH合并症发生率2.1%。结论较理想的TSH筛查切值为>9 m U/L;TCH预后优于PCH;初筛高TSH值者PCH可能性大;早产儿、低体重儿CH多为TCH;CH需重视长期随访和全身体检。
Objective To investigate the cut-off value of screening for congenital hypothyroidism (CH), the clinical characteristics of different categories, prognosis and related factors. Methods The clinical data of CH children diagnosed and followed up from August 1999 to April 2013 in our hospital were collected. The incidence of CH was analyzed. The thyroid stimulating hormone (TSH) levels were preliminarily measured. Preterm infants, low body weight Children CH clinical features; complications; According to the follow-up results distinguish between persistent hypothyroidism (PCH) and temporary hypothyroidism (TCH), the clinical characteristics of the two groups were compared, the prognosis and related factors were analyzed. Results A total of 789 CH 2 cases were diagnosed with a prevalence of 1/1 886. Among them, 69 (2.47%, 69/2 789) had TSH value of 9 ~ 10 mU / L and CH :1. The ratio of male to female: free thyroid hormone (FT4) returned to normal age, TSH value, initial dose, height, bone age and mental development between the two groups were statistically significant (all P <0.01) 56 cases (8.2%) were stopped and reused. CH11 of premature infants accounted for 22.2% of them, CH111 of low birth weight children and 34.2% of PCH, and CH complication rate was 2.1%. CONCLUSIONS: The ideal TSH screening score is> 9 mU / L; the prognosis of TCH is better than that of PCH; the probability of PCH with high TSH is high in preliminarily screening; CH is mostly TCH in preterm and low birth weight children; CH should pay attention to long-term follow-up And physical examination.