新生儿缺氧缺血性脑病甲状腺功能变化及替代治疗

目的 探讨新生儿缺氧缺血性脑病（ＨＩＥ）甲状腺功能的变化以及甲状腺素替代治疗对预后的影响。方法 应用放射免疫方法对ＨＩＥ患儿３日龄、７日龄及应用甲状腺素替代治疗的１４日龄患儿血清甲状腺激素水平进行动态观察，并将７日龄时血清甲状腺激素水平低下者随机分为２组，对照组继续ＨＩＥ常规治疗，治疗组在此基础上加用甲状腺片治疗，通过观察体温、进乳量的改善、体重的变化以及应用新生儿行为神经测查法（ＮＢＮＡ）进行评估。结果 ３日龄时中、重度ＨＩＥ患儿血清Ｔ３显著低下，各组间有显著性差异，７日龄时重度组Ｔ３仍显著下降，应用甲状腺素替代治疗组与常规治疗组相比ＮＢＮＡ评分、预后判定及进乳量的改善上均有显著性差异。结论 中、重度新生儿ＨＩＥ伴随甲状腺功能降低，且与疾病严重程度呈正相关，恢复期（７日龄）甲状腺功能不恢复者应用甲状腺片替代治

Alteration of thyroid function and replacement therapy in neonatal hypoxic-ischemic encephalopathy

Objective To investigate the influence on prognosis of neonatal hypoxic ischemic encephalopathy through observing the alternation of thyroid function and implementing the replacement therapy of thyroxine. Methods The radioimmunoassay was applied to observe a series of changes in serous thyroxine levels of patients aged 3 days, aged 7 days and patients aged 14 days who received thyroxine replacement therapy in HIE. Patients aged 7 days with low level of serous thyroxine were randomly classified into 2 groups, control group and therapy group. The control continually accepted the regular therapy of HIE, and the therapy were given thyroxine tablets in addition to the foundmental treatment. The effect were evaluated through observing the levels of temperature, improvement of feeding amount, and alteration of weight and applying the Neonatal Behavioral Neurologic Assessment (NBNA). Results The level of serous thyroxine T 3 considerably declines in 3 day old patients with moderate and serious HIE. Significant difference was observed among the groups. The level of serous T 3 still declines significantly in 7 day old patients with serious HIE. The NBNA evaluation, predicting of prognosis and the improvement of feeding amount all exist significant difference between the thyroxine replacement therapy and the regular therapy. Conclusion The function of thyroidea has declined in patients with moderate and serious neonatal HIE, and it is positively related with the severity of the disease. If the function of thyroidea doesn't go back to its normal level until the recuperating phase, the replacement therapy with thyroxine tablets can prompt the recovering of the disease and improve the prognosis.