亚临床甲状腺功能减退症孕妇左旋甲状腺素治疗剂量及影响因素的探讨  

Levothyroxine dosage and related factors in the treatment of pregnant women with subclinical hypothyroidism

作　　者：苏恒[1] 任秀莲[1] 马杉[1] 陈红[2] 薛元明[1] 张云[1] 朱宝生[2] 

机构地区：[1]昆明医学院附属昆华医院,云南省第一人民医院内分泌与代谢病科,650032 [2]云南省第一人民医院遗传诊断中心

出　　处：《中华内分泌代谢杂志》2012年第10期826-829,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：云南省中青年学术技术带头人后备人才项目（2007PY01-32）;云南省高层次人才培引工程（20080C009）

摘　　要：目的探讨亚临床甲状腺功能减退症（甲减）妇女妊娠期左旋甲状腺素（L—T4）替代治疗的剂量及其影响因素。方法纳入妊娠12周前确诊的亚临床甲减妇女56例，1组24例（2．5mIU／L≤TSH≤5．0mlU／L），2组32例（TSH〉5．0mlU／L），两组进一步分为甲状腺自身抗体阴性组及阳性组。给予L—L替代治疗，根据TSH水平调整L—T。治疗剂量，妊娠早期0．3mlU／L〈TSH〈2．5mlU／L、妊娠中晚期0．3mlU／L〈TSH〈3．0mlU／L为治疗达标。结果亚临床甲减孕妇TSH基线水平与L-T4替代治疗的达标剂量之间存在正相关关系（r=0．533，P〈0．01）；亚临床甲减1组与2组TSH达标时L—T4的剂量之间存在显著性差异[（0．583±0．341）对（0．961±0．405）斗昏／kg，t=-3．695，P〈0．01]；甲状腺自身抗体甲状腺过氧化物酶抗体（TPOAb）和（或）甲状腺球蛋白抗体（TGAb）阴性组与阳性组TSH达标时L—L的剂量之间存在显著性差异[（0．680-4-0．370）对（0．9184-0．440）μg/kg，t=-2．197，P=0．032]。结论亚临床甲减孕妇的TSH基线水平和甲状腺自身抗体TPOAb和（或）TGAb状况可能影响L—L替代治疗的达标剂量。Objective To study the levothyroxine doses and related factors in the treatment of pregnant women with subclinical hypothyroidism （SCH）. Methods Fifty-six pregnant women with SCH （ diagnosed before 12 weeks of gestation） were recruited and divided into 2 groups according to the baseline TSH levels, SCH group l （2.5 mlU/L ≤ TSH ≤ 5.0 mIU/L, n = 24） and SCH group 2 （ TSH〉5.0 mIU/L, n = 32 ）. Thyroid autoantibodies [thyroid peroxidase antibody（TPOAb） and thyroglobulin antibody（TGAb） ] were detected. All the subjects were treated with levothyroxine and the doses were adjusted according to the TSH level. The therapeutic target was to keep the TSH levels under control, 0. 3 to 2. 5 mIU/L for the first trimester and 0. 3 to 3.0 mIU/L for the second and third trimesters. Results There was a positive correlation between the levothyroxine doses and baseline TSH levels （ r = 0. 533, P〈0.01 ） in pregnant women with SCH. A significant difference in the levothyroxine doses between SCH group 1 and SCH group 2 was found I （0. 583 ±0. 341 ） vs （0. 961 ±0. 405） μg/kg, t=-3. 695, P〈0. 01 1- The ]evothyroxine doses in SCH group 2 were 64.84% higher than those in group 1. There was a significant difference in the levothyroxine doses between thyroid autoantibody negative and positive subjects [ （ 0. 680 ± 0. 370 ） vs （ 0. 918 ± 0. 440） wg/kg, t =-2. 197, P = 0. 0321. The levothyroxine doses in thyroid autoantibody positive subjects were 35 % higher than those in the negative subjects. In addition, there was a significant difference in the levothyroxine doses between subjects with negative and positive thyroid autoantibody [ （ 0.421 ± 0.192 ） vs （ 0. 720 ± 0. 385 ） μg/kg, t = -2.331, P = 0. 029 ] in SCH group 1. While in SCH group 2, the difference did not reach statistical significance. Conclusion The baseline TSH levels and status of thyroid autoantibodies may affect the levothyroxine dosage in pregnant women with SCH.

关 键 词：妊娠 甲状腺功能减退症 左旋甲状腺素 甲状腺自身抗体 

分 类 号：R581.2[医药卫生—内分泌]