左旋甲状腺素对甲状腺过氧化物酶抗体阴性的妊娠合并亚临床甲状腺功能减退症患者妊娠激素水平、甲状腺功能及妊娠结局的影响  

Effects of Levothyroxine on Pregnancy Hormone Levels, Thyroid Function and Pregnancy Outcome in Patients with Thyroid Peroxidase Antibody-Negative Pregnancy Complicated with Subclinical Hypothyroidism

作　　者：舒展[1] 房秋霞[1] 马恩萍 SHU Zhan;FANG Qiuxia;MA Enping(Dept.of Gynaecology and Obstetrics,Tangshan Union Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山市协和医院妇产科

出　　处：《中国医院用药评价与分析》2019年第7期815-817,821,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省医学科学研究重点课题计划项目(No.20150996)

摘　　要：目的:探讨左旋甲状腺素(L-T4)对甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阴性的妊娠合并亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)患者妊娠激素水平、甲状腺功能及妊娠结局的影响.方法:选取2016年2月至2018年1月唐山市协和医院收治的TPOAb阴性的妊娠合并SCH患者134例,采用随机数字表法分为观察组和对照组,每组67例.观察组患者给予L-T4治疗,对照组患者不采用药物干预.比较两组患者治疗前后血清妊娠激素[雌二醇(E2)、孕酮(P)和人绒毛膜促性腺激素(HCG)]水平、甲状腺功能指标[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)]水平的差异,并统计两组患者妊娠期并发症发生情况及妊娠结局.结果:治疗前后,两组患者E2、P和HCG水平的差异均无统计学意义(P>0.05).治疗后,观察组患者血清TSH水平明显低于对照组,差异有统计学意义(P<0.05);治疗前后两组患者血清FT3、FT4水平的差异均无统计学意义(P>0.05).观察组患者自然流产、妊娠糖尿病的发生率分别为4.48%(3/67)、7.46%(5/67),明显低于对照组的20.90%(14/67)、19.40%(13/67),差异均有统计学意义(P<0.05).两组患者早产,胎儿生长受限、胎儿窘迫、胎盘早剥、低出生体质量及围生儿死亡发生率的差异均无统计学意义(P>0.05).结论:L-T4可改善TPOAb阴性的妊娠合并SCH患者的甲状腺功能,减少相关妊娠期并发症的发生.OBJECTIVE:To investigate the effects of levothyroxine on pregnancy hormone levels,thyroid function and pregnancy outcome in patients with thyroid peroxidase antibody(TPOAb)negative pregnancy complicated with subclinical hypothyroidism(SCH).METHODS:Totally 134 patients with TPOAb negative pregnancy complicated with SCH admitted into Tangshan Union Hospital from Feb.2016 to Jan.2018 were extracted to be divided into the observation group and the control group via the random number table,with 67 cases in each group.The observation group was treated with L-T4,while the control group received no drug intervention.Differences of serum pregnancy hormone[estradiol(E2),progesterone(P)and human chorionic gonadotropin(HCG)]levels,thyroid function indicators[thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)]of two groups were compared,and the incidence of pregnancy complications and pregnancy outcome of two groups were analyzed.RESULTS:There was no significant difference in E2,P and HCG levels between two groups before and after treatment(P>0.05).After treatment,the serum TSH level of the observation group was significantly lower than that of the control group,with statistically significant difference(P<0.05).There was no significant difference in serum FT3 and FT4 levels between two groups before and after treatment(P>0.05).The incidence of spontaneous abortion and gestational diabetes in the observation group were respectively 4.48%(3/67)and 7.46%(5/67),significantly lower than those in the control group[20.90%(14/67)and 19.40%(13/67)],the difference was statistically significant(P<0.05).There was no significant difference in the incidence of premature delivery,fetal growth restriction,fetal distress,placental abruption,low birth weight and perinatal death between two groups(P>0.05).CONCLUSIONS:L-T4 can improve the thyroid function in patients with TPOAb negative pregnancy complicated with SCH and reduce the incidence of complications associated with pregnancy.

关 键 词：左旋甲状腺素 亚临床甲状腺功能减退症 妊娠激素 甲状腺功能 妊娠结局 

分 类 号：R977.14[医药卫生—药品]