妊娠合并临床甲状腺功能减退症患者控制与否对母婴结局的影响  

Controlled or uncontrolled clinical and subclinical hypothyroidism in pregnant women and its effect on obstetrical and neonatal outcome

作　　者：罗越 吴艺捷[1] 徐艳红[1] 蒋怡雅[1] 徐先明[2] 申玉红[2] 董玉英[2] 

机构地区：[1]上海交通大学附属第一人民医院内分泌科,上海200080 [2]上海交通大学附属第一人民医院产科,上海200080

出　　处：《中国医师杂志》2011年第11期1445-1448,1451,共5页Journal of Chinese Physician

基　　金：基金项目：上海市卫生局科研基金项目（054017）

摘　　要：目的探讨妊娠合并临床甲状腺功能减退症（甲减）病情控制与否对母婴结局的影响，为临床提供诊治依据。方法对本院168例合并临床或亚临床甲减的孕妇进行临床观察，其中甲减控制组9例，甲减未控制组29例，亚临床甲减组130例，并与正常孕妇组180例对照比较，分析各组孕妇妊娠结局和新生儿出生情况。结果与对照组相比，甲减控制组妊娠晚期游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）、促甲状腺激素（TSH）水平差异无统计学意义[（3．68±1．11）pmol／LVS（3．19±0．33）pmol／L，（15．48±4．14）pmol／LVS（13．95±1．68）pmol／L，1．87mU／LV81．76mU／L，P〉0．05]。甲减未控制组妊娠中、晚期血清FT3、FT4水平降低，TSH水平升高[（2．71±0．80）pmol／Lvs（3．14±0．34）pmol／L，（10．94±2．68）pmol／LVS（14．25±2．01）pmol／L，5．62mU／LVS2．28mU／L，（2．34±0．70）pmol／LVS（3．19±0．33）pmol／L，（10．16±1．65）pmol／LVS（13．95±1．68）pmol／L，7．13mU／LVS1．76mU／L，t=2．754～9．15，P〈0．01]，亚临床甲减组血清TSH水平升高（4．67mU／LVS2．28mU／L，5．25mU／LVS1．76mU／L，t=18．28，18．57，P〈0．01）。甲减控制组孕妇未发生围生儿不良结局，而甲减未控制组孕妇围生儿不良结局、产科并发症的发生率高于对照组（17．2％VS2．8％，37．9％V85．6％，x2=11．47，28．97，P〈0．01）。亚临床甲减组产科并发症的发生率较对照组升高（40．0％VS5．6％，x2=52．97，P〈0．01）。结论妊娠合并临床或亚临床甲减均可影响母婴结局，尤以临床甲减未控制者对母婴结局影响较大，甲减孕妇病情控制可改善母婴预后。Objetive To investigate the obstetrical and neonatal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods One hundred and sixty-eight pregnant women with clinical or subclinical hypothyroidism during pregnancy, including 9 controlled hypothyroidism, 29 uncontrolled hypothyroidism and 130 subclinical hypothyroidism, were enrolled in thisstudy. The general clinical information, obstetrical complications and neonatal outcomes of these pregnant women were compared with that of 180 healthy pregnant women who delivered during the same period. Results Compared with control group, there were no significant differences in the levels of serum free triiodothyronine（ FT3 ）, free thyroxine （ FT4 ）, thyrotropin-stimulating hormone （TSH） in the controlled hypothyroidism group in the third trimester [（3.68±1. 11） pmol/L vs （3. 19 ±0.33） pmol/L, （15.48 ±4. 14） pmol/L vs （13.95 ± 1. 68）pmol/L, 1.87 mU/L vs 1.76 mU/L, P 〉 0. 05 ]. However, in the second and third trimester, the levels of FT3, FT4 in the uncontrolled hypothyroidism group were lower, while the levels of TSH were higher than in control group [（2.71 ±0. 80） pmol/L vs （3. 14±0.34）pmol/L, （10.94 ± 2.68） pmol/L vs （14.25 ±2.01） pmol/L, 5. 62 mU/L vs 2. 28 mU/L, （2. 34 ± 0. 70） pmol/L vs （ 3.19 ± 0. 33 ） pmol/L, （ 10. 16 ± 1.65 ） pmol/L vs （ 13.95 ± 1.68）pmol/L,7. 13 mU/L vs 1.76 mU/L, t =2. 754 -9. 15, P 〈0. 01 ], the levels of TSH in the subclinical hypothyroidism were higher than in control group （ t = 18.28,18. 57, P 〈0.01 ）. There was no adverse perinatal outcome of neonate happened in controlled hypothyroidism group. In contrast, the incidences of adverse perinatal outcomes and complications in the uncontrolled hypothyroidism group were higher than that in the control group （ 17. 2% vs 2. 8% ,37. 9% vs 5.6% ,X2 = 11.47,28.97, P 〈 0.01 ）. Compared with that of control group, the incidences of adverse obstetrical outcomes in pregnant women with subcl

关 键 词：妊娠并发症/治疗 甲状腺功能减退症/并发症/治疗 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学] R581.2[医药卫生—临床医学]