CAJ | 학술논문

目的探讨先天性甲状腺功能减退症(CH)左旋甲状腺素钠(L-T_4)替代治疗的初始剂量.方法对筛查确诊的CH患儿分为A(n=36)、B(n=51)、C(n=40)3组,分别采用L-T_4 10、8和6 μg·kg~(-1)·d~(-1) 3种不同的初始剂量治疗,分别在治疗后第2周、4-6周、8～12周复查血清TSH、T_4和FT_4水平,根据结果进行L-T_4剂量的个体化调整.12周后每3个月复查1次,随访2年.期间定期进行患儿体格发育评价,甲状腺超声检查、骨龄检测和智能发育测定.结果127例患儿治疗2周,(1)TSH水平,A、B组迅速下降至正常范围[(1.3±1.5)mU/L和(3.7±5.6)mU/L],两组间差异无统计学意义(P=0.28),A组中8例(22.2%)TSH下降到0.5 mU/L以下;C组TSH均未降至正常[(11.4±16.5)mU/L],与A、B组比较有显著性差异(P<0.01),其中10例(25.0%)TSH>10 mU/L,平均值为(34.0±19.2)mU/L.(2)T_4、FT_4水平迅速提高,A组有9例(25.O%)T_4>250 nmol/L;11例(30.6%)FT_4>45 pmol/L,达到正常值高限的1.5倍,并出现高甲状腺素血症,13例(36.1%)患儿分别表现腹泻、烦躁、多汗、哭吵不安等甲状腺功能亢进的临床症状.治疗12周后3组间TSH、T_4和FT_4水平无显著差异,L-T_4剂量也无显著差异.治疗随访2年,127例身高、体重均达到相应年龄的正常范围(x±s);腕部骨龄成熟程度达到相应年龄,3组无显著性差异;智力发育达到正常水平,3组间差异无统计学意义(均P>0.05).结论L-T_4初始剂量(8.0±0.5)μg·kg~(-1)·d~(-1)是我国先天性甲状腺功能减退症初始治疗比较安全、合理、有效的剂量.CH替代治疗时,L-T_4剂量必须个体化,保持甲状腺功能与其年龄相匹配的水平,应能保证其体格和智能的正常发育.
목적 탐토선천성갑상선공능감퇴증(CH)좌선갑상선소납(L-T_4)체대치료적초시제량.방법대사사학진적CH환인분위A(n=36)、B(n=51)、C(n=40)3조,분별채용L-T_4 10、8화6 μg·kg~(-1)·d~(-1) 3충불동적초시제량치료,분별재치료후제2주、4-6주、8～12주복사혈청TSH、T_4화FT_4수평,근거결과진행L-T_4제량적개체화조정.12주후매3개월복사1차,수방2년.기간정기진행환인체격발육평개,갑상선초성검사、골령검측화지능발육측정.결과127례환인치료2주,(1)TSH수평,A、B조신속하강지정상범위[(1.3±1.5)mU/L화(3.7±5.6)mU/L],량조간차이무통계학의의(P=0.28),A조중8례(22.2%)TSH하강도0.5 mU/L이하;C조TSH균미강지정상[(11.4±16.5)mU/L],여A、B조비교유현저성차이(P<0.01),기중10례(25.0%)TSH>10 mU/L,평균치위(34.0±19.2)mU/L.(2)T_4、FT_4수평신속제고,A조유9례(25.O%)T_4>250 nmol/L;11례(30.6%)FT_4>45 pmol/L,체도정상치고한적1.5배,병출현고갑상선소혈증,13례(36.1%)환인분별표현복사、번조、다한、곡묘불안등갑상선공능항진적림상증상.치료12주후3조간TSH、T_4화FT_4수평무현저차이,L-T_4제량야무현저차이.치료수방2년,127례신고、체중균체도상응년령적정상범위(x±s);완부골령성숙정도체도상응년령,3조무현저성차이;지력발육체도정상수평,3조간차이무통계학의의(균P>0.05).결론L-T_4초시제량(8.0±0.5)μg·kg~(-1)·d~(-1)시아국선천성갑상선공능감퇴증초시치료비교안전、합리、유효적제량.CH체대치료시,L-T_4제량필수개체화,보지갑상선공능여기년령상필배적수평,응능보증기체격화지능적정상발육.
Objective The purpose of this study was to investigate the optimal initial dose of levothyroxine(L-T_4)for treatment of congenital hypothyroidism(CH).Methods One hundred and twenty-seven CH infants were assigned to A(n=36),B(n=51),and C(n=40)groups.Different initial doses were given to the patients,10 μg·kg~(-1)·d~(-1) for A group,8 μg·kg~(-1)·d~(-1) for B group and 6 μg·kg~(-1)·d~(-1) for C group.Blood TSH,L and FT_4 Ievels were determined at 2 weeks,4-6 weeks and 8-12 weeks after medication.L-T_4 dose was adiusted individually according to the blood hormone levels.Thyroid hormone levels were rechecked every three months after 12 weeks of medication.All the patients were followed up for 2 years,with regular assessment of growth,development,and thyroid ultrasonography.Results After 2 weeks'medication,TSH levels in both A and B groups were reduced to reference range[(1.3±1.5)mU/L and(3.7±5.6)mU/L].No difference was found between the 2 groups(P=0.28).Eight patients(22.2%)in the A group had a reduced TSH level to less than0.5 mU/L.TSH level in the C group remained abnormal[(11.4±16.5)mU/L]and significant difierence was observed when compared with those in the B and C groups(P<0.01).10 patients in the C group had a TSH level more than 10 mU/L[(34.0±19.2)mU/L].T_4 and FT_4 levels in all the three groups increased markedly.9patients(25.0%)in the A group had T_4 level more than 250 nmol/L,and 11 patients(30.6%)showed hyperthyroxinemia with FT_4 level more than 45 pmol/L(1.5 folds of upper limit of the reference range).13patients in the A group showed clinical symptoms of hyperthyroidism such as diarrhea,irritability,sweating,cry,and so on.After 12 weeks medication,no significant difference was found in blood TSH,T_4,and FT_4 levels among the 3 groups.Also no difference was observed in adjusted L-T_4 dosages among the 3 groups.After 2-year follow-up,clinical examinations including height,weight,bone age,and mental development were all normal for the patients.No differences were found among the 3 groups(all P>0.05).Conclusions Optimal initial dosage of L-T_4 for CH treatment in our country is(8.0±0.5)μg·kg~(-1)·d~(-1) which is proved to be safe and effective.L-T_4dosage should be individualized.To maintain the thyroid function in the age-matched normal reference will lead to normal growth and development.