论文部分内容阅读
目的:探讨先天性甲状腺功能低下症(congenital hypothyroidism,CH)的病因学分类,确定甲状腺发育、形态、位置变化与血清促甲状腺素(TSH)、T3、T4表达水平的关系。方法:采集1998～2007年济宁市新生儿出生72 h后血样滴于滤纸上,用酶免疫标记法测定TSH含量,用放射免疫分析法测定血清TSH、T4、T3含量,治疗前用放射性核素99mTcO4甲状腺静态显像确定甲状腺发育、位置,用秩和检验确定甲状腺变化与血清TSH、T4、T3表达的关系,确诊为CH的患儿给予左旋甲状腺素(L-T4)/优甲乐治疗并定期随访监测。结果:681 289例新生儿中确诊CH375例,发病率为1∶1 817;对其中367例CH患儿进行病因分类,其中203例为永久性CH,151例为暂时性CH,13例失访;甲状腺扫描显示甲状腺正常、发育不良、异位、缺如和摄锝功能低下的分别占61.03%、12.53%、10.08%、9.54%和6.81%。永久性CH中上述甲状腺的比例分别为30.44%、22.66%、16.75%、18.23%和12.32%,而暂时性CH甲状腺全部正常。暂时性甲状腺功能低下症和甲状腺基本正常的永久性甲状腺功能低下症患儿血清TSH、T4、T3含量与甲状腺形态和功能异常者比较差异有统计学意义(P<0.01),而甲状腺缺如、异位患儿血清TSH、T4、T3含量与甲状腺发育不良、摄锝功能低下患儿比较差异有统计学意义(P<0.01)。结论:永久性和暂时性CH的甲状腺形态、位置改变不同,血清TSH、T3、T4表达水平不同,可为先天性甲状腺功能低下症的病因分析、诊断、治疗和预后判断提供依据。
OBJECTIVE: To investigate the etiological classification of congenital hypothyroidism (CH) and to determine the relationship between thyroid development, morphology, and location changes and serum thyrotropin (TSH), T3 and T4 levels. Methods: Blood samples were collected on filter paper 72 hours after birth from 1998 to 2007 in Jining City. The content of TSH was determined by enzyme-linked immunosorbent assay (ELISA), and the contents of serum TSH, T4 and T3 were determined by radioimmunoassay. Before treatment, 99mTcO4 thyroid static imaging to determine thyroid development, location, rank sum test to determine the relationship between thyroid changes and serum TSH, T4, T3 expression, diagnosed with CH children given levothyroxine (L-T4) / Euthyrox and Regular follow-up monitoring. Results: Among 681 289 newborns, CH375 cases were diagnosed with a prevalence of 1: 1 817. Etiological classification was performed on 367 CH children, of which 203 were permanent CH, 151 were transient CH, and 13 were lost Thyroid scan showed normal thyroid gland, dysplasia, ectopic, absent, and hypothyroidism accounted for 61.03%, 12.53%, 10.08%, 9.54% and 6.81% respectively. The proportion of thyroid in the permanent CH were 30.44%, 22.66%, 16.75%, 18.23% and 12.32% respectively, while the temporary CH thyroid was all normal. The levels of serum TSH, T4 and T3 in children with transient hypothyroidism and thyroid hyponatremia were significantly different from those with thyroid morphology and dysfunction (P <0.01), while those with thyroid absence, Ectopic children with serum TSH, T4, T3 content and thyroid dysplasia, photo-technetium dysfunction in children with significant difference (P <0.01). CONCLUSION: The permanent and transient CH have different thyroid morphology and location, different levels of serum TSH, T3 and T4, which may provide the basis for the etiological analysis, diagnosis, treatment and prognosis of congenital hypothyroidism.