妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察  

A clinical analysis of subclinical hypothyroidism during pregnancy and the effect of thyroxine replacement therapy

作　　者：吴跃跃[1] 陈琳[2] 黄新梅[1] 孙田歌[1] 刘军[1] 杨敏[1] 张瑞[1] 徐炯[1] 盛励[1] 陈灶萍[1] 王芳[1] 

机构地区：[1]复旦大学附属上海市第五人民医院内分泌代谢科,上海200240 [2]复旦大学附属上海市第五人民医院妇产科,上海200240

出　　处：《中华内分泌代谢杂志》2017年第3期198-202,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨妊娠期亚临床甲状腺功能减退（甲减）对妊娠结局及围产儿的影响及甲状腺激素替代治疗作用的临床观察。方法回顾性分析2014年3月至2015年3月在本院分娩的妊娠期亚临床甲减孕妇216例（其中166例给予甲状腺素替代治疗），妊娠期甲减69例，随机选取同期分娩的正常孕妇406名作为对照，分析各组孕妇妊娠结局及围产儿的情况。结果各组在年龄、胎数、妊娠期高血压的患病率方面无明显差异。妊娠期亚临床甲减组、妊娠期甲减组的妊娠期糖尿病患病率均显著高于对照组（13．4％，17．4％对0．2％，P〈0．05）。妊娠期亚临床甲减组及妊娠期甲减组的甲状腺过氧化酶抗体及甲状腺球蛋白抗体阳性率均显著高于对照组（26．9％，23．2％对9．9％；15．7％，23．2％对8．1％，均P〈0．05）。妊娠期亚临床甲减组中未治疗及治疗者分别与对照组相比，在早产、Apgar评分、出生低体重、新生儿畸形、先天性甲减方面差异未见统计学意义（P〉0．05）；进一步分析妊娠期亚临床甲减组治疗与未治疗者之间在妊娠结局及围产儿方面差异同样未见统计学意义（P〉0．05）。结论妊娠期亚临床甲减对妊娠结局及围产儿方面未见明显影响。甲状腺素替代与否在妊娠期亚临床甲减的妊娠结局及围产儿方面也未见明显差异。Objective To investigate the maternal and fetal outcomes of pregnant women with subclinical hypothyroidism, and clinical observation of thyroxine replacement. Methods From March 2014 to March 2015, the clinical records of 216 women with subclinical hypothyroidism （including 166 cases with thyroxine replacement） , and hypothyroidism （ n = 69 ） during pregnancy who delivered at our hospital were reviewed. The maternal complications and neonatal outcomes were compared with 406 healthy women who delivered during the same period. Results The age, number of fetus, and morbidity rate of gestational hypertension were without significant differences in those groups. The morbidity of gestational diabetes in subclinical hypothyroidism group and hypothyroidism group were significantly higher than those in control group （13.4%, 17.4% vs O. 2%, P〈0.05 ）. The rate of thyroid peroxidase antibody and thyroglobulin antibody positive in subclinical hypothyroidism group and hypothyroidism group were significantly higher than those in control group （26.9% , 23.2% vs 9.9% ; 15.7% , 23.2% vs 8.1% , all P〈0.05 ）. No matter treated or not treated in subclinical hypothyroidism group, the preterm birth, Apgar score, low birth weight, birth defects, and infant congenital hypothyroidism were without significant differences as compared to the control group （ P 〉 0.05 ）. Further compared those between treated and untreated subclinical hypothyroidism, the results were also without significant difference （P〉0.05）. Conclusions Subclinical hypothyroidism had no significant influence on pregnancy outcomes and perinatal events. Thyroxine replacement in subclinical hypothyroidism pregnant women also had no significant influence on pregnancy outcomes and perinatal events.

关 键 词：妊娠期 亚临床甲状腺功能减退症 甲状腺素 妊娠结局 围产儿 

分 类 号：R714.256[医药卫生—妇产科学]