【摘要】 目的探讨不同剂量左甲状腺素治疗先天性甲状腺功能减低症(congenital hypothyroidism,CH)的临床疗效,以寻找最佳治疗剂量。方法选择CH 60例,随机分为低剂量组和常规剂量组各30例,均应用左甲状腺素治疗。常规剂量组起始剂量10~15μg/(kg·d),维持剂量80~100μg/d;低剂量组起始剂量8~10μg/(kg·d),维持剂量50~80μg/d。观察两组治疗2个月时甲状腺功能指标及治疗至2岁时智力情况。结果治疗2个月时,两组FT3和FT4差异无统计学意义(P>0.05);低剂量组TSH值(2.6±1.2)mU/L明显低于常规剂量组(11.3±8.2)mU/L,差异有统计学意义(P<0.01)。2岁时参照儿童韦氏智力测试量表(C-WYCSI)检测患儿操作智商(PIQ)、语言智商(VIQ)和总智商(FIQ)的变化情况,低剂量组各项指标均高于常规剂量组,差异有统计学意义(P<0.01)。结论应用低剂量左甲状腺素治疗CH有助于改善患儿的甲状腺功能和智力水平,推荐剂量为起始剂量8~10μg/(kg·d),维持剂量50~80μg/d。更多还原

【Abstract】 Objective To investigate the clinical efficacy of different doses levothyroxine in treatment of congenital hypothyroidism( CH) to find the optimal therapeutic dosage. Methods A total of 60 patients with CH were randomly divided into low-dose group( n = 30) and routine dose group( n = 30),and all patients received levothyroxine treatment. The routine dose group was treated with 10-15 μg /( kg·d) of initial dose and 80-100 μg / d of maintenance dose; the low-dose group was treated with 8-10 μg /( kg·d) of starting dose and 50-80 μg / d of maintenance dose. The thyreoid functional parameters in two groups were observed after treatment for 2 months,and intelligence status was also observed in patients who received continued treatment at the age of two. Results After treatment for 2 months,the differences of values of FT3and FT4in two groups were not statistically significant( P > 0. 05); TSH value of( 2. 6 ± 1. 2) mU / L in low-dose group was significantly lower than that of( 11. 3 ± 8. 2) mU / L in routine dose group,and the differences were statistically significant( P < 0. 01).The changes of performance intelligence quotient( PIQ),verbal intelligence( VIQ) and full-scale intelligence quotient( FIQ)were detected by Wechsler intelligence scale( C-WYCSI) when patients were two years old. The indexes in low dose group were significantly higher than those in routine dosage group,and the differences were statistically significant( P < 0. 01).Conclusion Low dose of levothyroxine in treatment of congenital hypothyroidism may improve thyroid function and intelligence level,and the recommended doses are 8-10 μg / d of initial dose and 50-80 μg / d of maintenance dose.更多还原