左旋甲状腺激素替代治疗妊娠期合并亚临床甲状腺功能减退对胎儿宫内发育及妊娠结局的影响  

Effect of L-thyroid hormone replacement therapy on intrauterine growth and pregnancy outcomes in pregnancy with subclinical hypothyroidism

作　　者：刘洪[1] 冯小兰[2] 袁晓玲 黄赞维[2] 秦清 陈一汶 LIU Hong;FENG Xiaolan;YUAN Xiaoling;HUANG Zanwei;QIN Qing;CHEN Yiwen(Department of Endocrinology, Science City Hospital of Mianyang City in Sichuan Province, Mianyang 621900,China;Department of Nephropathy, Science City Hospital of Mianyang City in Sichuan Province, Mianyang 621900,China)

机构地区：[1]四川省科学城医院内分泌科,四川绵阳621900 [2]四川省科学城医院肾病科,四川绵阳621900

出　　处：《中国现代医生》2018年第11期91-94,共4页China Modern Doctor

基　　金：四川省绵阳市卫生计生委医学科研课题(201683)

摘　　要：目的探讨左旋甲状腺激素替代治疗妊娠期合并亚临床甲状腺功能减退(SCH)对胎儿宫内发育及妊娠结局的影响。方法临床纳入我院2017年1月~2017年12月期间收治的400例妊娠期合并SCH患者作为研究对象,将其中进行左旋甲状腺激素替代治疗的孕产妇设为研究组,其余未给予左旋甲状腺激素进行替代治疗孕产妇设为对照组,均为200例。观察两组孕37w TSH水平及胎儿双顶径。另外,将两组孕产妇及新生儿并发症发生率进行比较,观察两组妊娠结局。结果研究组孕37w TSH水平明显低于对照组;而胎儿双顶径明显高于对照组,差异有统计学意义(t=-47.634、t=6.916,P<0.05);研究组共8例孕产妇出现并发症,其中妊娠期贫血2例、妊娠期高血压4例、早产2例,并发症发生率为4.00%;对照组共29例孕产妇出现并发症,其中妊娠期贫血7例、妊娠期高血压13例、胎盘早剥5例、早产4例,并发症发生率为14.50%。研究组孕产妇并发症发生率明显低于对照组,差异有统计学意义(χ~2=6.567,P=0.010);研究组共发生胎儿宫内窘迫2例、低出生体质量儿3例,并发症发生率为2.50%;对照组共27例新生儿发生并发症,其中胎儿宫内窘迫7例、低出生体质量儿20例,并发症发生率为13.50%,差异有统计学意义(χ~2=8.220,P=0.004)。结论妊娠期合并SCH与胎儿宫内发育及妊娠结局密切相关,通过早期积极进行替代治疗可明显减少孕产妇及新生儿并发症,改善妊娠结局,促进胎儿宫内发育,对保障母婴健康、促进优生优育具有积极意义,具备临床实施意义与运用价值。Objective To investigate the effect of L-thyroid hormone replacement therapy on intrauterine growth and pregnancy outcomes in pregnant women with subclinical hypothyroidism（SCH）. Methods 400 cases of pregnancy complicated with SCH admitted to our hospital from January 2017 to December 2017 were enrolled in this study. The pregnant women who underwent L-thyroid hormone replacement therapy were enrolled as the study group, while the rest cases who were not given L-thyroid hormone replacement therapy were enrolled as the control group, 200 cases in each group. Observed gestational 37 w TSH levels and fetal biparietal diameter of two groups. In addition, the incidence of maternal and neonatal complications of the two groups comparisons were compared to observe the pregnancy outcome of the two groups. Results The gestational 37 w TSH level in the study group was significantly lower than that in the control group; while the biparietal diameter of the fetus was significantly higher than that in the control group（t =-47.634, t=6.916）, P〈0.05, the difference was statistically significant; Complications occurred in 8 cases in study group,of which 2 cases of anemia during pregnancy, 4 cases of gestational hypertension, 2 cases of premature birth, the complication rate was 4.00%; as for control group, a total of 29 cases underwent complications, including 7 cases of anemia during pregnancy, 13 cases of gestational hypertension, 5 cases of placental abruption, 4 cases of premature birth, the complication rate was 14.50%. The incidence of maternal complications in the study group was significantly lower than that in the control group（χ^2=6.567, P=0.010）, and the difference was statistically significant. In the study group, there were 2 cases of fetal distress and 3 cases of low birth weight children with complications. The incidence of complications was 2.50% in the control group. There were 27 neonates with complications in the control group, including 7 cases of fetal distress and 20 cases of low birth weight.

关 键 词：妊娠期合并亚临床甲状腺功能减退(SCH) 胎儿宫内发育 并发症 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]