Toublanc J E, Ingrand J, Megarbane M, Fulla Y, Rives S
Département de pédiatrie, hôpital Saint-Vincent-de-Paul, Paris.
Arch Pediatr. 1994 Oct;1(10):872-8.
Screening for congenital hypothyroidism (CH) is an opportunity to investigate maturation by measuring alphafetoprotein (AFP).
Blood AFP was measured in 73 full-term infants (controls), 22 infants with permanent CH and 19 with a transient form (FT) of hypothyroidism. It was also measured in mothers of the two groups with hypothyroidism. AFP was measured by RIA and its value was compared to those of FT4, TSH and bilirubin.
Blood AFP was higher in patients with CH with significant differences between patients who had jaundice or not, but AFP was not significantly different in FT patients and controls. Initial values of AFP in both CH and FT population was correlated to the levels of AFP in their mothers. Under treatment with 7.5 micrograms/kg/day of l-T4, AFP levels remained increased at T15, then gradually normalized at T30-T60. The log of AFP was correlated to TSH levels between T15 and T60 but was not correlated to FT4 levels. Preliminary results at one year of age show that IQ seems better in infants with early normalization of AFP.
Prolonged follow-up is necessary to assess the possibility that initial kinetics of AFP under therapy have a prognostic value for estimating the quality of outcome.
筛查先天性甲状腺功能减退症（CH）是通过测量甲胎蛋白（AFP）来研究成熟度的一个契机。
对73名足月儿（对照组）、22名永久性CH患儿以及19名暂时性甲状腺功能减退症（FT）患儿测定血AFP。还对两组甲状腺功能减退症患儿的母亲进行了测定。通过放射免疫分析法测定AFP，并将其值与FT4、TSH和胆红素的值进行比较。
CH患者的血AFP较高，有黄疸和无黄疸患者之间存在显著差异，但FT患者与对照组的AFP无显著差异。CH和FT人群的AFP初始值与其母亲的AFP水平相关。在以7.5微克/千克/天的左甲状腺素（l-T4）治疗时，AFP水平在T15时仍升高，然后在T30 - T60时逐渐恢复正常。在T15至T60期间，AFP的对数与TSH水平相关，但与FT4水平无关。一岁时的初步结果显示，AFP早期恢复正常的婴儿智商似乎更高。
需要进行长期随访，以评估治疗过程中AFP的初始动力学对估计预后质量是否具有预后价值。
