目的 探讨早产儿甲状腺功能低下游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平变化的意义,左旋甲状腺素治疗对远期神经系统影响的价值.方法 将60例甲状腺功能低下早产儿随机分为治疗组和对照组,应用放射免疫法检测生后第1天,第1周、2周、4周、8周血清甲状腺功能低下FT3、FT4、TSH的水平,在5岁时采用CH/TS儿童健康测评系统工作站,评价其智商、认知功能等神经系统发育状态及脑瘫发生情况.结果 治疗组FT4升高较快,TSH亦明显下降.在第4周时,两组FT4和TSH的变化差异均有统计学意义(t值分别为8.174、6.267,均P<0.05),两组甲状腺功能低下FT3升高均较慢.5岁时治疗组神经发育异常发生率占16.67%,对照组占63.33%,两组差异有统计学意义(χ2=6.742,P<0.01).结论 两组在第8周时甲状腺功能低下FT3、FT4、TSH均可达到稳态水平,早期左旋甲状腺素干预治疗对远期神经精神发育的改善有非常重要的意义.%Objective To investigate the significance of changes of free triiodothyronine ( FT3 ) , free thyrine ( FT4 ) and thyroid-stimulating hormone ( TSH ) and to evaluate the effects of L-thyroxine treatment on nervous system of preterm infants with hypothyroidism. Methods Sixty cases of hypothyroidism in preterm infants were randomly divided into treatment group and control group. The serum FT3, FT4 and TSH were detected at one day, 1 week, 2 weeks, 4 weeks and 8 weeks after birth by radioimmunoassay. When they were 5 years old, their IQ, cognitive function and cerebral palsy and other nervous system development were evaluated by CH/TS Child Health Evaluation System workstation. Results In treatment group, FT4 was increased rapidly but TSH was decreased significantly. At week 4, there was significant differences in FT4 and TSH between two groups ( t value was 8. 174 and 6. 267, respectively, both P <0. 05 ). In both groups FT3 elevated slowly. The incidence of abnormal neural development was 16. 67% in treatment group and 63. 33% in control group at 5 years old, and the difference was significant (x2=6. 742, P <0. 01 ). Conclusion At week 8 FT3 , FT4 and TSH in both group can reach a stable level. Early intervention with L-thyroxine is very important to improve long-term neuropsychological development.
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