CAJ | 학술논문

目的：总结先天性甲状腺功能减低症(CH)筛查状况，并分析替代治疗疗效。方法采用时间分辨荧光免疫法测定新生儿滤纸干血片标本的促甲状腺激素(TSH)水平，阳性者召回并采用化学发光法检测静脉血TSH、游离甲状腺素以确诊。选取经确诊CH并规范治疗2年的永久性CH患儿54例(CH组)及正常健康儿童120例(对照组)，两组均长期监测体格发育，并于6月龄、24月龄时采用Gesell婴幼儿发育量表及儿童气质量表分别评估神经运动发育水平及气质特征。结果共筛查新生儿285242例，确诊140例，CH发病率1/2037。CH组及对照组的年龄别身高Z评分(LAZ)及年龄别体质量Z评分(WAZ)差异无统计学意义(P均>0.05)；6月龄、24月龄时CH组Gesell总发育商与对照组差异无统计学意义(P均>0.05)，但大运动发育商均落后于对照组，差异有统计学意义(P均<0.05)；6月龄、24月龄时，CH组和对照组气质类型的分布差异有统计学意义(P均<0.05)；相比对照组，CH组中难养型及中间偏难养型的比例较高。CH组与对照组在活动水平、适应性、反应强度及坚持性四个维度的得分差异有统计学意义(P均<0.05)。结论 CH患儿经早期替代治疗后体格生长及神经运动发育基本正常，但尚需关注其心理行为问题。
목적：총결선천성갑상선공능감저증(CH)사사상황，병분석체대치료료효。방법채용시간분변형광면역법측정신생인려지간혈편표본적촉갑상선격소(TSH)수평，양성자소회병채용화학발광법검측정맥혈TSH、유리갑상선소이학진。선취경학진CH병규범치료2년적영구성CH환인54례(CH조)급정상건강인동120례(대조조)，량조균장기감측체격발육，병우6월령、24월령시채용Gesell영유인발육량표급인동기질량표분별평고신경운동발육수평급기질특정。결과공사사신생인285242례，학진140례，CH발병솔1/2037。CH조급대조조적년령별신고Z평분(LAZ)급년령별체질량Z평분(WAZ)차이무통계학의의(P균>0.05)；6월령、24월령시CH조Gesell총발육상여대조조차이무통계학의의(P균>0.05)，단대운동발육상균락후우대조조，차이유통계학의의(P균<0.05)；6월령、24월령시，CH조화대조조기질류형적분포차이유통계학의의(P균<0.05)；상비대조조，CH조중난양형급중간편난양형적비례교고。CH조여대조조재활동수평、괄응성、반응강도급견지성사개유도적득분차이유통계학의의(P균<0.05)。결론 CH환인경조기체대치료후체격생장급신경운동발육기본정상，단상수관주기심리행위문제。
Objectives To summarize screening and therapeutic effects of congenital hypothyroidism (CH) in Zhongshan. Methods The thyroid stimulating hormone (TSH) concentration in dried heel blood samples on iflter paper was detected using time-resolved fluorescence immunoassay. The cases of positive screening tests were called back for further examination of venous blood TSH concentration using chemiluminescence method. Fifty-four children with permanent CH treated routinely for 2 years (CH group) and 120 age-gender matched health children (control group) were recruited. The physical development (height, body weight) was monitored. The neurodevelopment and temperament type were tested using Pediatric Nneuropsychological Development Assessment and Children's Temperament Scale respectively at 6 and 24 months after birth. Results Two hundred eight-five thousand two hundred forty-two neonates were screened. One hundred and forty cases were confirmed and the incidence rate was 1/2037. There was no statistical difference in length-for-age z score (LAZ) and weight-for-age z score (WAZ) between CH and control group (P>0.05). The neurodevelopment in CH group was normal, but gross motor development was worse than that in control group (P<0.05). The temperament type and distribution had statistical difference between CH and control group (P<0.05). The percentage of the dififcult type and central dififcult type was increased in CH group as compared to control group, especially in the activity, adaptability, reaction intensity and perseverance (P<0.05). Conclusions The physical and neurodevelopment are nearly normal in patients with CH after early supplementation, but the psychological behavior problems need to be focused on in the process of intervention.