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感染与先天性甲状腺功能减退症患儿的甲状腺功能障碍有关。

Infection Is Associated With Thyroid Dysfunction in Children With Congenital Hypothyroidism.

作者信息

Silva Ivani Novato, Marçal Lara Vieira, Queiroz Dulciene Maria Magalhães

机构信息

Pediatrics Department, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

出版信息

Front Pediatr. 2022 Jun 21;10:875232. doi: 10.3389/fped.2022.875232. eCollection 2022.

Abstract

() infection leads to a systemic low-grade inflammatory state and has been associated causally with a diverse spectrum of extra-gastric disorders. Among them, the infection has been involved in the pathogenesis of autoimmune thyroid disease (ATD), but only one study had evaluated children. Therefore, a cross-sectional study was conducted in a cohort of 142 children and adolescents, randomly assessed among those followed up for thyroid diseases in a university pediatric endocrinology service: 106 with congenital hypothyroidism (CH) and 36 with ATD. All children were asymptomatic, under strict control on levothyroxine replacement, and reported no other diseases or use of drugs. status was evaluated by the C-Urea Breath Test (C-UBT). Antithyroid antibodies (ATPO, antiTg, and TRAb) and serum thyroid hormones (TSH, free T4, and T3) were assessed by standard assays. Data were analyzed in logistic models by the SPSS statistical software package, and a -value ≤ 0.05 was considered statistically significant. The prevalence of infection was 19.44% in children with ATD. Neither the gender nor the serum levels of thyroid hormones and antithyroid antibodies were associated with the -positive status. Thirty-seven (34.90%) children with CH were infected with . The mean T3 serum level (3.59 ± 0.84) was significantly lower ( = 0.001) in the infected children than in those free from the infection (3.95 ± 0.89), association that remained after adjustment for the other variables in the multivariate analysis. Because no difference was observed in the levels of TSH and T4, the results indicate that the infection may lead to impairment in the thyroid hormonal balance, but not in the hypothalamic-pituitary-thyroid axis function. In as much as infection is highly widespread and the prevalence of CH is also not negligible, additional studies are required to confirm our results and to identify the involved mechanisms.

摘要

()感染会导致全身性低度炎症状态,并与多种胃外疾病存在因果关联。其中,该感染参与了自身免疫性甲状腺疾病(ATD)的发病机制,但仅有一项研究评估了儿童。因此,对一组142名儿童和青少年进行了一项横断面研究,这些儿童和青少年是在一所大学儿科内分泌科接受甲状腺疾病随访的人群中随机抽取的:106例先天性甲状腺功能减退症(CH)患儿和36例ATD患儿。所有儿童均无症状,接受左甲状腺素替代治疗且控制严格,未报告其他疾病或用药情况。通过C - 尿素呼气试验(C - UBT)评估()感染状态。通过标准检测方法评估抗甲状腺抗体(ATPO、抗Tg和TRAb)以及血清甲状腺激素(TSH、游离T4和T3)。使用SPSS统计软件包在逻辑模型中分析数据,P值≤0.05被认为具有统计学意义。ATD患儿中()感染的患病率为19.44%。性别、甲状腺激素和抗甲状腺抗体的血清水平均与()检测阳性状态无关。37例(34.90%)CH患儿感染了()。感染患儿的血清T3平均水平(3.59±0.84)显著低于未感染患儿(3.95±0.89)(P = 0.001),在多变量分析中对其他变量进行调整后该关联依然存在。由于TSH和T4水平未观察到差异,结果表明该感染可能导致甲状腺激素平衡受损,但不会影响下丘脑 - 垂体 - 甲状腺轴功能。鉴于()感染非常普遍且CH的患病率也不可忽视,需要进一步研究来证实我们的结果并确定其中涉及的机制。

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本文引用的文献

1
An update on non-thyroidal illness syndrome.非甲状腺疾病综合征的最新进展。
J Endocrinol Invest. 2021 Aug;44(8):1597-1607. doi: 10.1007/s40618-020-01482-4. Epub 2020 Dec 15.
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infection: Beyond gastric manifestations.感染:超越胃部表现。
World J Gastroenterol. 2020 Jul 28;26(28):4076-4093. doi: 10.3748/wjg.v26.i28.4076.
4
Evaluation and management of the child with hypothyroidism.儿童甲状腺功能减退症的评估和管理。
World J Pediatr. 2019 Apr;15(2):124-134. doi: 10.1007/s12519-019-00230-w. Epub 2019 Feb 8.

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