早产儿暂时性甲状腺功能障碍分析与治疗

摘要

目的 探讨早产儿暂时性甲状腺功能障碍的情况及左旋甲状腺素治疗的疗效.方法 对165例早产儿进行血清FT4、T4、FT3、T3、TSH检测,对FT4、T4降低的早产儿按甲状腺功能低下症状有无分为观察组与对照组,对T3降低的早产儿随机分为观察组与对照组,观察组予左旋甲状腺素治疗,定期复查血清FT4、T4、FT3、T3、TSH.结果 ①早产儿暂时性甲状腺功能障碍发生率为47.27％,胎龄越小,发生率越高.其中胎龄28～30周发生率为77.27％,30～32周75％,32～34周39.47％,34～36周32.47％.②低甲状腺素血症观察组早产儿经左旋甲状腺素治疗后症状消失,血清FT4及T4恢复正常时间较对照组快.生后14天观察组FT4、T4100％恢复正常,对照组44.4％恢复正常,P=0.00.③低T3综合征早产儿观察组与对照组的TSH、T3恢复正常所需时间无差别.生后28天观察组TSH、T315％恢复正常,对照组10％恢复正常,P=1.00.结论早产儿生后甲状腺功能暂时性低下,胎龄越小,功能越低.对于有甲状腺功能低下临床症状的早产儿予短期左旋甲状腺素治疗有助于改善甲状腺功能.%Objective To explore the thyroid function and curative effect with thyroid hormone supplementation in premature infants.Methods Serm thyroid-stimulating hormone(TSH),total thyroxine (TT4),free thyroxine(FT4),total triodothyrorine(TT3) and free triodothyrorine(FT3) were detected in 165 premature infants.Premature infants with low TT4 and low FT4 were divided into Levothyroxine group and control group according to clinical symptom; premature infants with low TT3 were randomized into Levothyroxine group and control group.Levothyroxine group received Levothyroxine,TSH,TT4,FT4,TT3 and FT3 were detected once a week.Results ①The thyroid function in the premature infants was transiently low.The shorter the gestational age,the lower the thyroid function.The incidence rate of 28 ～ 30 weeks of gestational age,30 ～ 32 weeks of gestational age,32 ～ 34 weeks of gestational age and 34 ～ 36 weeks of gestational age were 77.27％,75％,39.47％ and 32.47％ respectively.② symptom disappeared after Levothyroxine supplementation in premature infants with low TT4 and low FT4.Time of reaching normal range of the thyroid hormone in Levothyroxine group was significantly shorter than that of control group.The normal rate of serum concentrations of FT4,T4 on the 14th day after birth in Levothyroxine group was 100％,That in control group was 44.4％.(P =0.00).③ Time of reaching normal range of the thyroid hormone was not significantly different between Levothyroxine group with low TT3 and control group with low TT3.The normal rate of serum concentrations of TSH,T3 on the 28th day after birth in Levothyroxine group was 15％,while that in control group was 10％ (P=1.00).Conclusion The thyroid function in the premature infants is transiently low.The shorter the gestational age,the lower the thyroid function.Thyroid hormone replacement therapy in premature infants with a symptom of transient hypothyroxinemia is useful.