左旋甲状腺素治疗对亚临床甲状腺功能减退症孕妇血清叶酸和甲状腺功能的影响  

Effect of levothyroxine on the serum concentration of folate acid and thyroid function in pregnant women with subclinical hypothyroidism

作　　者：周竟雄[1] 李鲁宏[2] 李婷[1] 张子平[1] 罗湘闽[2] 黄素真[2] 李希圣[1] 

机构地区：[1]福建医科大学附属第二医院内分泌科,福州362000 [2]福建医科大学附属第二医院妇产科,福州362000

出　　处：《中国临床药理学杂志》2015年第19期1913-1915,1930,共4页The Chinese Journal of Clinical Pharmacology

基　　金：泉州市科技局社会发展计划重点基金资助项目(2011Z40)

摘　　要：目的探讨左旋甲状腺素治疗对亚临床甲状腺功能减退症(SCH)孕妇血清叶酸和甲状腺功能的影响。方法选取妊娠中晚期孕妇及体检中心常规体检的育龄妇女95例,分为妊娠期SCH组(A组,30例)、妊娠期甲状腺功能正常组(B组,35例)及育龄期甲状腺功能正常组(C组,30例),妊娠期SCH组患者接受左旋甲状腺素治疗,妊娠期SCH患者在治疗前及治疗8周后,其他受试者在治疗前空腹采静脉血,检测叶酸、促甲状腺激素、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)。结果 A组血清叶酸水平显著低于B、C组(P<0.01)。A组总胆固醇,水平亦显著高于B、C组(P<0.01)。孕妇血清促甲状腺激素与叶酸水平存在弱的负相关(r=-0.20,P>0.05),与总胆固醇、LDL-C水平呈正相关(均P<0.05)。治疗后,A组患者叶酸显著升高,血清促甲状腺激素显著降低(均P<0.05),而FT3,FT4水平无明显变化(均P>0.05)。结论叶酸水平降低和高总胆固醇、LDL-C水平可能是SCH孕妇发生不良妊娠结局的危险因素。左旋甲状腺素治疗能升高SCH孕妇的血清叶酸水平,降低血清促甲状腺激素水平,对改善妊娠结局可能有积极意义。Objective To investigate the effect of levothyroxine on the serum concentration of folate acids and thyroid function in pregnant women with subclinical hypothyroidism. Methods A total of 95 subjects including 65 pregnant women during the second and third trimesters and30 controls were involved in this study. The participants were divided into three groups based on the thyroid function： 30 pregnant women with subclinical hypothyroidism（ A group）,35 pregnant women with normal thyroid function（ B group） and 30 fertile women with normal thyroid function（ C group）. The patients in A group were treatment with levothyroxine. The levels of folate,thyroid stimulating hormone,free thyroxine（ FT4）,free triiodothyronine（ FT3）,fasting plasma glucose,total cholesterol,triglyceride,high density lipoprotein- cholesterol（ HDL- C）,low density lipoprotein- cholesterol（ LDL- C） were detected before and after treatment. Results Serum folate concentration in the A group were significantly lower than that in the B group and C group（ P〈0. 01）. Levelsof total cholesterol and LDL- C in the A group were significantly higher than those in the B group and C group（ P〈0. 01）. The level of thyroid- stimulating hormone has a mild inverse correlation with the level of folate concentration（ r =- 0. 20,P〉0. 05）,but has a positive correlation with total cholesterol and LDL- C levels（ r = 0. 21 and0. 29,P〈0. 05,respectively） in pregnant women. In A group patients,folate concentration significantly increased,but the level of thyroid- stimulating hormone level significantly decreased after treatment（ both P〈0. 05）. The changes of free triiodothyronine or free thyroid hormone level was not significantly（ both P〉0. 05）. Conclusion Lower folate concentration,higher total cholesterol and LDL- C levels may be considered as risk factors of bad pregnancy outcomes in pregnant women with subclinical hypothyroidism. Treatment with levothyroxine can significantly increase serum folate and reduce th

关 键 词：左旋甲状腺素 甲状腺功能减退症 妊娠 叶酸 

分 类 号：R581.2[医药卫生—内分泌] R977.14[医药卫生—内科学]