不同剂量左甲状腺素治疗妊娠合并甲状腺功能减退症疗效评价  

Effect of different doses of levothyroxine in the treatment of pregnant women complicated with hypothyroidism

作　　者：张玲[1] 牛建生[1] ZHANG Ling;NIU Jian-sheng(Department of Endocrinology,Second Hospital of Yulin City,Yulin 719000,Shaanxi,CHINA)

机构地区：[1]榆林市第二医院内分泌科

出　　处：《海南医学》2020年第4期452-455,共4页Hainan Medical Journal

摘　　要：目的评价不同剂量左甲状腺素治疗妊娠合并甲状腺功能减退症患者的临床效果。方法选取2016年7月至2018年7月期间就诊于榆林市第二医院内分泌科的110例妊娠合并甲状腺功能减退症患者为研究对象,按随机数字表法分为小剂量组和大剂量组,每组55例,分别予以50μg/d、150μg/d剂量左甲状腺素钠维持治疗8周。比较两组患者治疗前后的甲状腺激素、血脂和叶酸水平;比较两组患者的妊娠结局、妊娠期并发症和药物不良反应发生率;比较两组新生儿出生6个月后的婴幼儿发育量表(BSID)、智能发育指数(MDI)、运动发育指数(PDI)。结果治疗后,大剂量组患者的血清TSH和TPOAb分别为(2.49±0.43) mU/L、(23.20±6.38) mU/L,明显低于小剂量组的(2.61±0.51) mU/L、(30.85±7.93) m U/L,而血清叶酸为(13.79±2.22) ng/mL,明显高于小剂量组的(11.37±2.01)ng/mL,差异均有统计学意义(P<0.05);大剂量组新生儿出生6个月的BSID评分为(121.21±7.96)分、MDI为(122.74±8.62)分、PDI为(119.73±9.54)分,均优于小剂量组新生儿的(114.41±6.17)分、(116.21±6.39)分、(112.95±7.47)分,差异均有统计学意义(P<0.05);小剂量组患者的药物不良反应发生率为9.09%,明显低于大剂量组的21.82%,差异有统计学意义(P<0.05)。结论大剂量左甲状腺素治疗妊娠合并甲状腺功能减退症患者可显著改善甲状腺功能,降低血脂,提高叶酸,有效的提高新生儿发育水平。但由于用药量较大的原因,药物不良反应发生率高。Objective To investigate the effect of different doses of levothyroxine tablets in the treatment of pregnant women with hypothyroidism. Methods A total of 110 pregnant women with hypothyroidism were randomized into high dose group and low dose group by random number table. The women in the low dose group(n=55) were given50 μg/d levothyroxine, and the women in the high dose group(n=55) were given 150 μg/d levothyroxine, for 8 weeks.The changes of thyroid function indexes of women before and after treatment in two groups were detected, and rate of complications were compared between the two groups. The neonatal development scale(BSID) was used to assess neonatal development at 6 months after birth, which included intelligence development index(MDI) and motor development index(PDI). Results After treatment, the serum TSH and TPOAb in the high dose group were(2.49 ± 0.43) m U/L and(23.20±6.38) mU/L, significantly lower than(2.61±0.51) mU/L and(30.85±7.93) mU/L in the low dose group, while the serum folate was(13.79±2.22) ng/mL, significantly higher than(11.37±2.01) ng/mL in the low dose group(P<0.05). The scores of BSID, MDI, and PDI were(121.21±7.96) points,(122.74±8.62) points, and(119.73±9.54) points in the high dose group, which were better than(114.41±6.17) points,(116.21±6.39) points and(112.95±7.47) points in the low dose group(P<0.05). The incidence of adverse drug reactions was 9.09% in the low dose group, which was significantly lower than 21.82% in the high dose group(P<0.05). Conclusion High dose of levothyroxine in the treatment of pregnant women with hypothyroidism can significantly improve thyroid function, reduce blood lipids, increase folic acid, and effectively improve the level of neonatal development. However, due to the large dosage, the incidence of adverse drug reactions is high.

关 键 词：妊娠合并甲状腺功能减退症 左甲状腺素片 剂量 妊娠结局 不良反应 

分 类 号：R714.256[医药卫生—妇产科学]