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【目的】通过对先天性甲状腺功能减低症(congenital hypothyroidism,CH)初始治疗后甲功恢复情况及其影响因素的分析,探讨不同病情程度的适宜初始甲状腺激素用量。【方法】以北京市2001—2009年经新生儿疾病筛查程序诊治的CH患儿为研究对象,采用促甲状腺激素作为代表参数,对治疗后1月的甲功结果进行评价并分析其相关因素。【结果】初始治疗1月后,308例CH中甲功低下52例(16.88%)、正常219例(71.1%)、继发甲亢37例(12.01%);3组病例T4及FT4呈现特殊的变化特点,均高于常规诊断范围。相关因素分析显示:在标准剂量条件下,不同病情程度CH的初治结果差异存在统计学意义:T4>20 nmol/L组治疗后甲功正常率(89.58%)明显高于T4≤20 nmol/L组(59.49%);而后者治疗不充分发生率(40.51%)显著高于前者(10.42%)。【结论】CH治疗初始阶段T4应维持在较高水平;不同病情程度的CH应选用不同的初始剂量方案。
【Objective】 To investigate the recovery of thyroid function and its influencing factors after initial treatment of congenital hypothyroidism (CH), and to explore the appropriate initial thyroid hormone dosage for different severity of illness. 【Methods】 CH children diagnosed and treated by neonatal disease screening program in Beijing from 2001 to 2009 were selected as the research object. Thyroid-stimulating hormone was used as a representative parameter to evaluate the clinical outcome of 1 month after treatment and to analyze its related factors . 【Results】 One month after the initial treatment, 52 cases (16.88%) of 308 CH patients were hypopigmented, 219 cases (71.1%) were normal, and 37 cases (12.01%) were secondary hyperthyroidism. T4 and FT4 showed special Change characteristics are higher than the conventional diagnosis. Correlation analysis showed that there was a statistically significant difference in the results of initial treatment of CH with different severity at standard dose: the normal thyroid function (89.58%) in T4> 20 nmol / L group was significantly higher than that in T4≤20 nmol / L group (59.49%), while the latter was not treated adequately (40.51%) was significantly higher than the former (10.42%). 【Conclusion】 T4 should be maintained at a high level in the initial stage of CH treatment; different initial dose regimens should be used for CH with different disease severity.