左旋甲状腺素早期干预对亚临床甲状腺功能减退症孕妇妊娠结局影响  

Early intervention of levothyrocine on pregnancy outcomes with subclinical hypothyroidism

作　　者：雷晓静 韩克[1] 陈茂林 汪美侨 LEI Xiaojing;HAN Ke;CHEN Maolin;WANG Meiqiao(Department of gynaecology,Nanjing Drum Tower Hospital The Affilioted Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of gynaecology and obstetrics,Maanshan Municipal Hospital Group Municipal Health Hospital for Women and Children,Maanshan 243000,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇科,江苏南京210008 [2]马鞍山妇幼保健院妇产科,安徽马鞍山243000

出　　处：《现代仪器与医疗》2018年第4期76-78,共3页Modern Instruments & Medical Treatment

摘　　要：目的 :观察左旋甲状腺素早期干预对亚临床甲状腺功能减退症(Subclinical hypothyroidism,SCH)孕妇妊娠结局的影响,探讨其临床应用价值。方法 :对174例SCH孕妇(SCH组)及同期50名甲状腺功能正常孕妇(对照组)开展前瞻性对照分析。将SCH组孕妇随机分为治疗组、非治疗组各87例。治疗组孕妇接受左旋甲状腺素早期干预并持续至分娩。检测各组孕妇孕早期甲状腺功能,对比三组孕妇妊娠并发症及不良结局发生情况,总结SCH对孕妇妊娠结局的影响以及左旋甲状腺素的早期干预效果。结果 :治疗组、非治疗组入组时TSH高于对照组,差异有统计学意义(P<0.05),三组孕妇FT3、FT4比较,差异无统计学意义(P>0.05)。非治疗组自发性流产、妊娠期糖尿病、妊娠期高血压发生率均高于治疗组、对照组,差异有统计学意义(P<0.05);治疗组与对照组妊娠并发症发生情况比较,差异无统计学意义(P>0.05)。三组孕妇妊娠结局比较,差异无统计学意义(P>0.05)。结论 :孕早期SCH并不会对孕妇妊娠结局造成明显影响,但左旋甲状腺素早期干预可降低孕妇妊娠期并发症发生率,也应纳入抗甲状腺过氧化物酶抗体(TPOAb)阴性SCH孕妇的妊娠期干预策略。Objective： The objective of this study was to observe the early intervention of levothyrocine on pregnancy outcomes with subclinical hypothyroidism（SCH）, and to explore its clinical value. Methods： 174 pregnancies with SCH were selected as the SCH group and 50 pregnancies with normal thyroid function were chosen as the control group. The SCH group was further randomly divided into the treatment and non-treatment group, with 87 cases in each group. The treatment group was given the levothyrocine intervention until delivery. The thyroid function of each group was examined, and the complications and adverse outcomes were compared between these three groups. The impacts of SCH on the pregnancy outcome and levothyrocine intervention were concluded. Results： The thyroid stimulating hormone（TSH） of treatment and non-treatment groups when initially enrolled were higher than that of the control group, and the difference was statistically significant（P〈0.05）. The differences of free Triiodothyronine（FT3） and free Thyroxine（FT4） between the three groups were not statistically significant（P〉0.05）. The incidence of spontaneous abortions, gestational diabetes mellitus and pregnancy induced hypertension in the non-treatment group were higher than those in the treatment group and control group, and the differences were statistically significant（P〈0.05）. The difference of pregnancy complications between the treatment and control groups was not statistically significant（P〉0.05）. The pregnancy outcomes were compared between three groups, and the differences were not statistically significant（P〉0.05）. Conclusions： SCH in the gestational earlier period will not have any noticeable impact on the pregnancy outcome. Early intervention of levothyrocine can reduce the incidence of pregnancy complications, and the intervention strategies for TPOAb-negative SCH pregnancy should be considered as well.

关 键 词：左旋甲状腺素 亚临床甲状腺功能减退症 孕妇 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]