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目的探讨心脏疾患及合并充血性心力衰竭(CHF)患儿心衰时,血清甲状腺激素(TH)水平的变化规律及临床意义。方法对2003-09—2006-09山西省阳泉市第一人民医院收治的116例心脏疾病患儿分为2组,心脏病合并CHF组82例,心脏病未合并CHF组34例,以28例健康体检儿童为对照组,均做如下检测及分析:(1)检测CHF患儿血清TH水平,包括三碘甲状腺原氨酸(T3)、游离T3(FT3)、甲状腺素(T4)、游离T4(FT4)、反T3(rT3)及促甲状腺激素(TSH),三组间进行比较。(2)以血清TH水平与心功能进行相关分析。(3)动态观察CHF患儿的血清TH水平,探索其变化规律。结果(1)CHF组与N-CHF组及正常对照组比,血清T3、FT3及FT4均显著降低(P<0.01),rT3显著升高(P<0.01)。(2)随心功能的下降,T3、FT3、T4、FT4渐降低,rT3渐升高。TSH与心功能变化无相关性。(3)CHF组经治疗后血清TH多恢复(P<0.01),顽固性心衰组则无恢复(P>0.05)。结论(1)小儿CHF伴有血清TH的改变,以T3、FT3及FT4的降低,rT3的升高为主,其改变程度与心功能状态具有相关性。(2)随着心功能的改善,TH的改变多渐恢复,顽固性心衰患儿则无恢复,提示TH水平持续不恢复者预后较差。     

窒息新生儿甲状腺激素水平的变化及其临床意义

目的探讨足月新生儿窒息后血清甲状腺激素水平的变化及其临床意义。方法采用化学发光法测定52例足月窒息新生儿(重度窒息20例、轻度窒息32例)和35例健康足月儿出生1天及10天的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)含量,并观察其动态变化。结果生后第1天窒息组FT3、FT4明显低于对照组(P<0.01),重度窒息组低于轻度窒息组(P<0.05);重度窒息组TSH明显高于对照组(P<0.01),轻度窒息组与对照组间TSH差异无统计学意义(P>0.05)。10天后各组FT3、FT4、TSH差异无统计学意义(P>0.05)。生后1天时窒息组FT3、FT4低于正常值的比例和TSH高于正常值的比例均高于对照组(P<0.05),轻度窒息组FT3、FT4低于正常值的比例高于对照组(P<0.05),TSH高于正常值的比例与对照组比较差异无统计学意义(P>0.05),生后10天时各组各指标异常率差异无统计学意义(P>0.05)。结论新生儿窒息可导致甲状腺功能受损,且随窒息程度加重而加重,血清甲状腺激素水平对判断窒息新生儿病情及观察疗效有一定意义。     

苯巴比妥,苯妥英,卡马西平对癫痫患儿甲腺激素的影响

观察常用抗癫痫药物对癫痫患儿血清甲状腺激素的影响,对无甲状腺功能减退临床表现的癫痫患儿共８０例,应用ＲＩＡ法测定血清ＴＴ４、ＴＴ３、ＦＴ４、ＦＴ３、ｒＴ３、ＴＳＨ浓度。结果未经治疗癫痫患儿所有激素水平与正常对照组比较无显著差异,苯巴比妥组ＦＴ４值低于正常对照组。     

抗癫癎药物对维生素D代谢的影响

目的：探讨3种小儿常用抗癫痫药（苯巴比妥、卡马西平及丙戊酸钠）对癫痫患儿维生素D代谢的影响。方法：用放射免疫法检测癫痫服药患儿及对照组儿童血清25－（OH）D3水平。结果：各抗癫痫药组与对照组相比，25－（OH）D3均显著降低（P＜0．01）。结论：上述小儿常用3种抗癫痫药物，均可影响患儿体内维生素D的正常代谢。     

内分泌系统疾病

00287,病理性新生儿甲状腺激素的变化及其临床意义/张善云…//四川医学一1999,20(5).一488~489 采用放射免疫法测血清T3、T‘、TSH,结果:二组的检测结果在性别上无差异。病理组中早产儿和足月低体重儿和血清TSH低于对照组(P<0.05),其余各类疾病的TSH值与对照组无显著差异(P>。.05),而病理组的血清T3、T4值均低于对照组,有显著差异(尸<0.01)。表1参2(姜红) 002880卡马西平对癫痛患儿甲状腺激素水平影响的临床观察/王临旭…//中国实用儿科杂志一2000,15(1)一26一27 平均治疗3个月后,T4、FT;分别为(1 13.1士40.6)mmol/L和(16.6士3.6)pm…     

奥卡西平对局限性发作癫(癎)患儿血清甲状腺激素水平的影响

目的 探讨奥卡西平(OXC)单药治疗对癫(癎)患儿甲状腺激素水平的影响.方法 对18例门诊初诊为局限性发作的癫(癎)患儿(治疗组)行OXC单药治疗,采集用药前、平均治疗3个月及1 a后晨空腹静脉血3 mL,用放射免疫法检测其血清四碘甲腺原氨酸(T4)、游离四碘甲腺原氨酸(FT4)、三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)及促甲状腺激素(TSH)水平,并以18例健康儿童作为健康对照组.治疗组与健康对照组性别、年龄无统计学差异.结果 OXC治疗前T4、FT4、T3、FT3、TSH与健康对照组比较均无统计学差异(Pa >0.05).OXC治疗3个月,T4、FT4均比治疗前明显减低,差异均具有高度显著性(Pa <0.01),T3、FT3、TSH与治疗前比较均无统计学差异(Pa >0.05).OXC治疗1 a,T4、FT4与治疗前比较差异均具有高度显著性(Pa <0.01),T3与治疗前比较亦有显著差异(P<0.05),FT3、TSH与治疗前比较无统计学差异(Pa >0.05).OXC治疗1 a,T4、FT4、T3、FT3与治疗3个月相比均无统计学差异(Pa >0.05).结论 OXC长期或短期应用均可影响癫(癎)患儿甲状腺激素水平,OXC治疗期间须定期监测癫(癎)患儿的甲状腺功能.     

急性白血病化疗对垂体、性腺、甲状腺激素的影响

目的评价儿童急性白血病(AL)及联合化疗对其垂体、性腺、甲状腺激素的影响。方法测定37例(男23例,女14例)AL患儿化疗前后和20例对照组血清促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)、催乳素(PRL)、生长激素(GH)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平。结果AL患儿FSH、LH、T、E2、GH、FT4、TSH水平化疗前后及对照组各组差异无显著意义(P>0.05),PRL水平治疗前高于对照组(P<0.01),男童PRL水平治疗前后比较差异有显著意义(P<0.01)。FT3治疗前低于对照组(P<0.001),治疗后趋于正常(P>0.05)。结论AL本身及联合化疗对患儿垂体-性腺轴功能及GH水平无明显影响。AL本身可使PRL水平升高,而化疗药物可抑制男童PRL的分泌。联合化疗对甲状腺功能无影响,FT3水平对判断AL患儿病情变化、疗效及预后有一定参考意义。     

窒息新生儿甲状腺功能测定及临床意义

目的　 探讨新生儿窒息后血清甲状腺激素的变化及其临床意义。 方法 　对 80例新生儿窒息患儿和 40例正常新生儿 ,用放射免疫法测定血中甲状腺激素 ,即游离T3 、T4(FT3 、FT4)及TSH值 ,并进行对比观察。 结果 　窒息新生儿FT3 值显著低于正常对照组 (t=3 90 9,P <0 0 0 1) ,且以重度窒息组更甚 ,FT4及TSH两组无明显差异 (P >0 0 5 )。 结论 　新生儿窒息后可出现甲状腺功能低下 ,窒息患儿血中FT3 显著低于正常新生儿 ,重度窒息患儿血中FT3 更低 ,提示甲状腺激素降低的程度与病情严重程度呈正相关。血清甲状腺激素水平测定可作为窒息新生儿病情判断 ,疗效观察及预后估计的一项参考指标。     

苯巴比妥卡马西平对癫痫儿童智力和适应能力影响的研究

目的 研究苯巴比妥和卡马西平长期服用对癫痫患儿智能的影响。方法 选择新近诊断的原发性强直阵挛性癫痫、无明显智力低下,且单药治疗有效者。随机分为苯巴比妥和卡马西平组,并设一正常对照组。采用自身对照方式,分别于治疗前、治疗半年或两年半后测查韦氏智测、社会适应能力、P300,并进行家长问卷调查。综合判断患儿智力功能。结果癫痫组治疗前,智商和社会适应能力正常者分别占47.62%和69.84%;而对照组分别为93.33%和96.67%。P300潜伏期延长者在癫痫组占30%。三组儿童言语智商、操作智商、总智商以及P300潜伏期治疗前后差异均无显著性(P>0.05)。直线相关分析示：总智商与语文、数学成绩呈正相关(r=0.49,P<0.01,r=0.53,P<0.01)。与P300潜伏期呈负相关(r=-0.46,P<0.01)。结论常规剂量下苯巴比妥、卡马西平长期服用对癫痫患儿智力无明显影响,应正规服药     

小剂量甲状腺素对顽固性心力衰竭治疗作用的临床研究

目的探讨小儿心脏疾患及合并充血性心力衰竭（CHF）时血清甲状腺激素（TH）的变化规律。以及应用小剂量甲状腺素治疗顽固性CHF的疗效。方法（1）检测CHF患儿血清TH水平，并观察血清TH水平与心功能的相关关系。（2）观察联合小剂量甲状腺素治疗顽固性CHF的疗效。结果（1）CHF患儿血清TT3、TT4、FT3及FT4均显著降低（P〈0．05），rT3显著升高（P〈0．05）。随着心功能的下降，TT3、FT3、TT4、FT4渐降低，rT3渐升高。（2）CHF纠正后血清TH多恢复（P〈0．01），而顽固性CHF组血清TH水平较治疗前差异无显著性（P〉0．05）。（3）顽固性CHF患儿，佐以小剂量甲状腺素治疗后心功能明显改善。结论（1）小儿CHF伴有TH水平，其改变程度与心功能状态具有相关性。随着心功能的改善，TH水平多见恢复，顽固性CHF患儿则无恢复。（2）联合小剂量甲状腺素对顽固性CHF有一定疗效。     

Effects of anticonvulsant drugs on thyroid hormones in epileptic children.

Serum total and free thyroid hormones, reverse T3 (rT3), thyroxin binding globulin (TBG) and thyroid stimulating hormone (TSH) concentrations were measured in 35 epileptic patients receiving anticonvulsants (phenobarbitone, phenytoin). There was a significant reduction found in total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3) and rT3 in the group treated with, phenytoin. The thyroid hormone levels were within normal limits in the group receiving phenobarbitone.     

甲状腺素水平改变对抗癫癎药物治疗的影响

目的探讨甲状腺素水平改变对抗癜癎药物(AEDs)治疗效果的影响.方法采用免疫细胞化学染色法,将实验组Wistar大鼠分别予以苯巴比妥、苯巴比妥加甲状腺素、苯巴比妥加丙硫氧嘧啶等处理.处理4周后用马桑内酯(CL)诱发癫癎.2.5 h后,采血测定甲状腺激素指标,并测脑星形胶质细胞胶质原纤维酸性蛋白(GFAP)的表达.结果苯巴比妥组和苯巴比妥加丙硫氧嘧啶组游离甲状腺素较对照组明显降低(P＜0.01),促甲状腺激素显著增高(P＜0.01),GFAP免疫反应显著减弱(P＜0.01).苯巴比妥加甲状腺素组GFAP免疫反应明显减弱(P＜0.01).结论甲状腺素可使癫癎大鼠脑内GFAP表达抑制,甲状腺素水平升高可能增强苯巴比妥抗癫癎的效果.     

先天性甲状腺功能减退症新生儿心电图改变的意义

目的评价先天性甲状腺功能减退症(CH)新生儿的心电图(ECG)改变,及与血清甲状腺激素(TH)水平的相关性,探讨TH减少对新生儿心脏电生理活动的影响。方法对50例CH新生儿(日龄17～28d)和35例健康新生儿(健康对照组)进行常规十二导联ECG检查,分别检测心率(HR)、PR间期(PR)、QT间期(QT)、QRS波电轴(QRSa)、QRS波时限(QRS)、校正QT间期(QTC)等,同时用化学发光法测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)和促甲状腺素(FSH)水平,对心电图指标和血TH水平行相关性分析。结果与健康对照组相比,CH组血清FT3、FT4、TT3、TT4水平显著降低,TSH水平显著升高(Pa<0.001);CH组HR显著低于健康对照组,PR及QT较健康对照组显著延长(Pa<0.05),但二组QRSa、QRS及QTC差异均无统计学意义(Pa>0.05)。HR与FT3、FT4呈显著正相关,与TSH呈显著负相关(Pa<0.05);PR间期与FT3、FT4、TT4呈显著负相关,与TSH呈显著正相关(Pa<0.05);但QT、QRS、QRSa及QTC与血TH水平均无明显相关(Pa>0.05)。结论CH可对新生儿窦房结起搏产生显著影响,引起心脏自律性改变,而心肌动作电位、房室传导等电生理活动则尚未受影响。     

Thyroid function in fetus and mother during the second half of normal pregnancy

Thyroid hormones, thyroxine-binding globulin (TBG) and thryrotropin (TSH) concentrations were measured in 46 paired fetal and maternal blood samples collected between 17 and 36 weeks of gestation. The samples were selected retrospectively from fetuses that had undergone cordocentesis for prenatal diagnosis, had been found to be unaffected and confirmed healthy at birth. In maternal serum, total thyroxine (TT4) and triiodothyronine (TT3) concentrations were high, but free thyroxine (FT4) and free triiodothyronine (FT3) were within normal adult ranges; reverse T3 (RT3) increased and TSH levels decreased towards term. Fetal TT4, FT4, TT3, FT3, TBG and TSH levels significantly increased whereas RT3 sharply decreased with gestational age. The ratio of fetal TSH/FT4 significantly decreased, suggesting that the set point for negative feedback of pituitary TSH secretion is changing while the sensitivity of the thyroid gland to TSH increases throughout gestation. There was no significant correlation between the maternal and fetal TBG, TSH, TT4 and FT4, whereas maternal TT3 was positively correlated with fetal TT4, FT4, TT3 and FT3. Normal reference values for maternal and fetal iodothyronines, TBG and TSH throughout the second half of gestation provide insight into fetal thyroid development and may be useful for prenatal diagnosis.     

Thyroid dysfunction in antiretroviral treated children

BACKGROUND: A high rate of thyroid disorders has been described in HIV-infected adults treated with highly active antiretroviral therapy (HAART), but data on children are lacking. We aimed to assess thyroid function in pediatric patients. METHODS: Fifty-two HIV-infected children receiving HAART were assessed for signs of thyroid dysfunction and serum concentrations of thyrotropin (TSH), free thyroxin (FT4), free triiodothyronine (FT3), thyroglobulin (TG), reverse triiodothyronine (rT3), anti-TG and antimicrosomal (anti-TSM) antibodies. RESULTS: Eighteen (35%) children showed thyroid abnormalities: isolated low FT4 value in 16; subclinical hypothyroidism in 1; and symptomatic hypothyroidism in 1.Children with low FT4 values as compared with the 34 children without thyroid dysfunction were similar for stage of disease, number of patients with undetectable HIV-RNA, FT3, TSH, TG, rT3, anti-TSM and anti-TG values, whereas they had shorter duration of HAART exposure (P = 0.019) and lower CD4 cell percentage (P = 0.035). The thyrotropin-releasing hormone (TRH) test was normal in all children with low FT4 values. Among children with low FT4, FT4 concentrations correlated positively with CD4 cell percentage (P < 0.05) and duration of HAART exposure (P < 0.05).The case with subclinical hypothyroidism had high basal TSH (7.3 microunits/ml), normal TSH response to TRH test and normal FT4, FT3, TG, rT3, anti-TG and anti-TSM antibodies.The case with symptomatic hypothyroidism had low FT4 (6.6 pg/ml) and high TSH (44 microunits/ml), TG (55 ng/ml), anti-TG (666 IU/ml) and anti-TSM (123 IU/ml). CONCLUSION: Thyroid abnormalities occur frequently in HAART-treated children even in the absence of clinical symptoms. These data suggest a need of regular thyroid function monitoring.     

特发性肾病综合征患儿血清游离甲状腺激素检测的临床意义

探索特发性肾病综合症（ＩＮＳ）患儿血清游离甲状腺激素（ＴＨ）、甲状腺激素结合球蛋白（ＴＢＧ）的变化情况及其变化的机理和临床意义。对１６例ＩＮＳ患儿及１５例正常儿童对照,用放免法测Ｔ３、Ｔ４、ＦＴ３、ＦＴ４,化学发光酶免疫分析法测ＴＳＨ、ＴＢＧ,放射配基单点饱和饱和结合分析法测糖皮质激素受体（ＧＣＲ）。结果：①ＩＮＳ患儿Ｔ３、Ｔ４、ＦＴ３、ＦＴ４均低于对照组,ＴＳＨ升高,差异非常显著。②ＴＢＧ降低,ＴＢＧ与ＴＨ呈正相关。③ＩＮＳ患儿ＧＣＲ升高,ＴＨ与ＧＣＲ未见相关性。提示对糖皮质激素（ＧＣ）治疗敏感的ＩＮＳ患儿,虽然其ＴＨ是降低的,但其ＧＣＲ是升高的。     

Thyroid hormone levels and their relationship to survival in children with bacterial sepsis and septic shock

OBJECTIVES: Reported studies have showed alternations of thyroid hormones in critical illness mostly in adults and some in children. In this study, we aimed to measure thyroid hormone levels in children with sepsis and septic shock and investigate the relationship of these hormones with clinical state and survival. PATIENTS AND METHODS: Thyroid hormone levels of children with sepsis and septic shock, and age- and sex-matched controls were measured. RESULTS: There were 51 children in sepsis (group S), 21 children in septic shock (group SS) and 30 in the control (group C) group. Total triiodothyronine (TT3) levels were (nmol/l): 0.91 +/- 0.22, 0.64 +/- 0.23, 2.11 +/- 0.59; free triiodothyronine (FT3) (pmol/l): 0.027 +/- 0.006, 0.018 +/- 0.007, 0.049 +/- 0.010; total thyroxine (TT4) (nmol/l): 100.62 +/- 21.93, 65.79 +/- 19.35, 109.65 +/- 19.35; free thyroxine (FT4) (pmol/l): 18.06 +/- 3.87, 10.32 +/- 1.29, 19.35 +/- 3.87; and thyroid stimulating hormone (TSH) (mIU/ml): 5.0 +/- 2.0, 4.8 +/- 2.4, 5.2 +/- 3.0, in children with sepsis, septic shock, and controls, respectively. The TT3, FT3, TT4, and FT4 levels of group SS were significantly lower than those of groups S and C. The TT3 and FT3 levels of group S were lower than in group C, but there was no significant difference between TT4, and FT4 levels of groups S and C. TSH levels were slightly decreased in both sepsis and septic shock, but the difference was not significant. Eleven (21.6%) children with sepsis and 15 (71.4%) children with septic shock died (p < 0.001). The levels of TT3, FT3, TT4 and FT4 were markedly lower in non-survivors of groups S and SS compared to survivors (p < 0.001). CONCLUSIONS: These changes in the hypothalamo-pituitary-thyroidal axis may suggest a possible prognostic value of thyroid hormone levels in children with sepsis and septic shock. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of patients with sepsis and septic shock with those in healthy controls in childhood.     

Euthyroid sick syndrome in children with acute viral hepatitis A.

According to the clinical findings, the activity of serum asparate aminotransferase (EC 2.6.1.1), alanine aminotransferase (EC 2.6.1.2) and the level of total bilirubin, 45 children with acute viral hepatitis A were divided into two groups: with mild and moderately severe degree of disease. By determining the products of the peripheral thyroxine metabolism-T3 and rT3, as well as the other thyroid parameters (T4, FT4, TSH and TBG) we have found significantly lower T3 level and significantly higher T4 and TBG levels in both groups of patients in comparison with control group. At the same time, the level of biologically less active rT3 was increased in patients with moderately severe form of disease, while no differences were found in the values of TSH between the ill and control patients. TRH induced TSH release was normal in all patients. The results of this study point to the development of euthyroid sick syndrome or low T3 syndrome in children with viral hepatitis A.     

Disorders of thyroid gland function--hypothyroidism in childhood. An ambulatory follow-up study

42 children with different kinds of hypothyroidism, who had been treated with thyroid hormones during several years, were thoroughly follow-up examined in 1988. Apart from few exceptions, patients in therapy attained standard data in length. Concerning skeleton maturation, clear differences between boys and girls were found. While male patients, with one exception, showed a retardation of bone-age, in females both, retardation and acceleration of bone-development were found. Serum concentration of FT4 and FT3 were chosen as hormonal parameter, and TSH was taken basal and after stimulation with TRH. Normal FT4 levels were found in 29 patients. In 5 children FT4 was significantly lower, in 8 cases an elevation of this serum-parameter was observed. Measurement of serum FT3 in 27 patients showed normal levels in 18 children. In 4 cases low and in 5 elevated FT4 levels were found. 29 patients had basal TSH concentrations within normal range, in 13 the estimated levels were elevated. TRH-stimulation carried out on 40 children showed normal serum TSH response for 13 of them. In 14 children an exaggerated TSH response to TRH occur, in 13 TSH still remain low after stimulation with TRH. Serum-GOT, -GPT, -Gamma GT and -CK were determined as encymic parameters. In 5 patients a typical hypothyroidism-associated GOT- and CK-elevation was found. 3 children showed an isolated rise of GOT-, 8 an isolated CK-elevation.