先天性甲状腺功能减退症的严重程度及治疗充分性对青少年学业成绩的影响：一项基于人群的队列研究。

Influence of severity of congenital hypothyroidism and adequacy of treatment on school achievement in young adolescents: a population-based cohort study.

作者信息

Léger J, Larroque B, Norton J

机构信息

Paediatrics Endocrinology Unit, Hôpital Robert Debré, Paris, France.

出版信息

Acta Paediatr. 2001 Nov;90(11):1249-56. doi: 10.1080/080352501317130272.

DOI:10.1080/080352501317130272

PMID:11808894

Abstract

AIM

To evaluate whether precociously treated subjects with congenital hypothyroidism (CH) are at risk of poor school performance in early adolescence, and to investigate which factors affect their school achievement.

METHODS

All children treated early for congenital hypothyroidism and born in France during the first 7 y (1979-1985) of the national screening program for congenital hypothyroidism were selected for the study. School performance during childhood, assessed according to age at entry into the first grade of secondary school, was evaluated as normal (usually 11 y of age) vs late entry (> or = 12 y). The national register of children with congenital hypothyroidism enabled a comparison to be made with data from the national population for the same school years.

RESULTS

School achievement was similar among the 682 patients with CH and in the national population. After an adjustment for the sex and socioprofessional category of the parents, the severity of CH as assessed by the type (athyreosis. the most severe vs other types), the initial low serum T4 levels (< or = 53 nmol/L vs >53 nmol/L), and the profound bone maturation delay (absence vs presence of the two knee epiphyseal ossification centres at diagnosis), initially low L-thyroxine dosage (below vs > or = 7 microg/kg/day), the absence of near normalization of thyroid hormone levels after 15 d of treatment and poor adequacy of treatment throughout childhood were associated with an increased risk of school delay. School achievement was unaffected by the age at start of treatment (mean age = 22.8 +/- 6.8 d). In a multivariate logistic regression analysis, recurrent episodes of insufficiently suppressed TSH levels (> or = 15 mUi/L at least four times during follow-up from the age of 6 mo onwards) were the most important variable associated with school delay.

CONCLUSION

Careful follow-up of the adequacy of treatment is required throughout childhood, to reduce the risk of school delay.

摘要

目的

评估先天性甲状腺功能减退症（CH）早期接受治疗的患者在青春期早期学业成绩不佳的风险，并调查哪些因素会影响他们的学业成就。

方法

选取在法国全国先天性甲状腺功能减退症筛查项目的前7年（1979 - 1985年）出生且早期接受先天性甲状腺功能减退症治疗的所有儿童作为研究对象。根据进入中学一年级的年龄评估儿童期的学业成绩，分为正常入学（通常为11岁）和延迟入学（≥12岁）。先天性甲状腺功能减退症儿童国家登记册使得能够将这些数据与同学年的全国人口数据进行比较。

结果

682例CH患者的学业成就与全国人口相似。在对父母的性别和社会职业类别进行调整后，CH的严重程度由类型（无甲状腺，最严重型与其他类型）、初始低血清T4水平（≤53 nmol/L与>53 nmol/L）、严重的骨成熟延迟（诊断时无两个膝关节骨骺骨化中心与有）、初始低左旋甲状腺素剂量（低于与≥7μg/kg/天）、治疗15天后甲状腺激素水平未接近正常以及整个儿童期治疗不充分相关，这些因素与学业延迟风险增加有关。学业成就不受治疗开始年龄（平均年龄 = 22.8 ± 6.8天）的影响。在多因素逻辑回归分析中，促甲状腺激素（TSH）水平未充分抑制的复发事件（从6个月龄起随访期间至少4次≥15 mU/L）是与学业延迟相关的最重要变量。