目的 探讨甲状腺激素替代治疗后的先天性甲状腺功能减低症(congenital hypothyroidism,CH)患儿的转归及其影响因素,为正确评估预后,探索更完善的治疗、随访方案提供依据。方法 选取2007年1月以来在本院筛查并确诊的CH患儿经甲状腺激素替代治疗2~3年停药后,并继续随访1年以上者为研究对象。根据停药后的甲状腺功能将他们分为三组:永久性CH组、高TSH血症组、恢复正常组,同时分析三组患儿近3岁时的智能、身高和初始FT4值、甲状腺组织。结果 三组患儿的智能、身高发育差异无统计学意义,初始FT4值在三组患儿中差异有统计学意义(F=3.65,P=0.032), 甲状腺组织异常在三组患儿中差异有统计学意义(χ²=25.093,P=0.000)。结论 初始FT4值和甲状腺组织是否异常对CH患儿的转归有影响,加强对停药后高TSH血症者的随访与治疗。

Objectives To investigate the outcome after thyroid hormone replacement therapy of preschool children with congenital hypothyroidism and its influencing factors,to evaluate the prognosis,treatment correctly,and provide the basis for the exploration of more perfect follow-up program. Methods Since 2007,cases were selected for screening and diagnosed in Maternal and Child Health Care Hospital that CH children after thyroid hormone replacement therapy for 2~3 years then were stopped,and continued to follow up more than one year.According to the thyroid function after discontinuation,they were divided into three groups:CH group,high TSH group and normal group.Intelligent,height,initial FT4 value and thyroid tissue of three groups were analysed at the same time. Results The intelligence and height development of children in three groups had no significant differences.The initial FT4 value had significant difference in three groups of children (F=3.65,P=0.032).The thyroid tissue abnormalities had significant difference in three groups of children(χ²=25.093,P=0,000). Conclusion Initial FT4 value and thyroid tissue abnormalities in children with CH have effects on prognosis;Follow-up of high TSH after treatment should be strengthened.