目的:本研究旨在探讨小剂量左旋甲状腺素(LT4)对新生儿甲状腺功能减退症(NH)患者心房利钠肽(ANP)和c型利钠肽(CNP)水平的影响。
方法:在这项回顾性研究中,选取2014年10月至2018年2月浙江中医药大学附属第一医院筛查出并确诊的90例NH患者作为研究组.80名同期接受体检的健康儿童作为对照。观察LT4治疗前后血清促甲状腺激素(TSH)和游离甲状腺素(FT4)水平的变化,评估ANP和CNP水平的变化及其与临床疗效的关系。此外,比较两组患者治疗前后身体生长发育情况及中国-韦氏幼儿智力量表(C-WYCSI)评分,并对研究组患儿的心功能变化进行评价。采用logistic回归分析治疗后精神异常的独立危险因素。
结果:治疗后,患者的TSH水平下降,而T3,T4,游离三碘甲状腺原氨酸(FT3)的水平,FT4增加了,组间无显著差异。治疗后,患者的ANP水平升高,但CNP水平降低。ANP水平与临床疗效呈负相关,但CNP水平与其呈正相关。超声心动图显示心功能改善。治疗后,与治疗前相比,身体的生长发育和C-WYCSI评分增加。首次访问日期,T3、FT4、TSH是儿童精神障碍的独立危险因素。
结论:对于患有NH的儿童,低剂量LT4可以纠正甲状腺功能水平,促进身心发展,提高ANP和CNP水平。
OBJECTIVE: This study was designed to explore the effects of low-dose levothyroxine (LT4) on levels of atrial natriuretic peptide (ANP) and c-type natriuretic peptide (CNP) in neonates with hypothyroidism (NH).
METHODS: In this retrospective study, a total of 90 cases of NH screened out and confirmed by the First Affiliated Hospital of Zhejiang Chinese Medical University from October 2014 to February 2018 were selected as a study group. 80 healthy children who underwent physical examination during the same time period were enrolled as controls. Before and after treatment with LT4, the changes in the levels of serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were observed, and the changes in the levels of ANP and CNP and their relationships to clinical efficacy were evaluated. Additionally, the growth and development of body and the scores of the China-Wechsler Younger Children Scale of Intelligence (C-WYCSI) were compared before and after the treatment, and the changes in the cardiac functions of children in the study group were evaluated. Independent risk factors for mental abnormality after treatment were analyzed by logistic regression.
RESULTS: After treatment, TSH levels in patients declined, while the levels of T3, T4, free triiodothyronine (FT3), and FT4 increased, without significant differences between groups. After treatment, ANP levels in patients increased but CNP levels decreased. ANP levels were negatively correlated with clinical efficacy, but CNP levels were positively correlated with it. Ultrasonic cardiography showed the improved cardiac functions. After treatment, the growth and development of body and the C-WYCSI scores increased compared to those before treatment. First visit date, T3, FT4, TSH were independent risk factors for mental disorders in children.
CONCLUSIONS: For children with NH, low-dose LT4 can correct the level of thyroid function, promote physical and mental development, and improve the levels of ANP and CNP.