高剂量THR治疗GDM合并甲减疗效及对脂代谢和妊娠结局影响  

Analysis of the efficacy of high-dose THR for treatment of GDM complicated with hypothyroidism and its influence on their fat metabolism and pregnancy outcomes

作　　者：哈丽亚·哈力木别克[1] 沈娟娟[1] 蔡珏瑾[1] HALIYA·Halimubieke;SHEN Juanjuan;CAI Juejin(The Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830000)

机构地区：[1]新疆医科大学第二附属医院,乌鲁木齐830000

出　　处：《中国计划生育学杂志》2021年第4期735-738,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨高剂量甲状腺激素替代疗法(THR)对妊娠期糖尿病(GDM)合并甲减患者疗效及对糖脂代谢和妊娠结局的影响。方法:选取本院2019年6月—2020年2月收治的GDM合并甲减患者(均为单胎)100例,分为两组各50例,分别采用常规治疗联合高剂量THR(高剂量组)或联合低剂量THR(低剂量组),比较两组临床疗效。结果:治疗4周后高剂量组临床总有效率(90.0%)高于低剂量组(74.0%),血清游离甲状腺素(12.9±3.8 pmol/L)、游离三碘甲状腺原氨酸(4.5±0.8pmol/L)和促甲状腺激素(6.6±1.2 mU/L)水平均较低剂量组改善明显,空腹血糖及血脂代谢水平均较低剂量组改善明显,不良妊娠结局发生率(16.0%)低于低剂量组(34.0%)(P<0.05)。结论:高剂量THR治疗GDM合并甲减患者疗效更显著,不仅可改善患者甲状腺功能和脂代谢能力,最还可有效降低不良妊娠结局发生率,但需根据患者耐受性随访、检测和调整,避免产生严重后果。Objective:To explore the effect of high-dose THR for treating women with gestational diabetes mellitus(GDM)and hypothyroidism,and to study its influence on their fat metabolism and pregnancy outcomes.Methods:100 singleton pregnant women with GDM and hypothyroidism were selected and were divided into two groups(50 cases in each group)from June 2019 to February 2020.The women in the research group were given conventional treatment combined with high-dose THR,and the women in the control group were given conventional treatment combined with low-dose THR.The clinical efficacy of the women was compared between the two groups.Results:After 4 weeks of treatment,the total clinical effective rate(90.0%)of the women in the research group was significant higher than that(74.0%)of the women in the control group.The improved levels of serum free thyroxine(12.9±3.8 pmol/L),free triiodothyrogenine(4.5±0.8 pmol/L),and thyrotropin(6.6±1.2 mU/L)of the women in the research group were significant more than those of the women in the control group.The improved levels of fasting blood glucose and lipid metabolism of the women in the research group were significant more than those of the women in the control group.The incidence of adverse pregnancy outcomes(16.0%)of the women in the research group was significant lower than that(34.0%)of the women in the control group(P<0.05).Conclusion:High-dose THR for treating women with GDM and hypothyroidism is more effective,which can not only improve thyroid function and lipid metabolism,but also effectively reduce the incidence of adverse pregnancy outcomes.However,follow-up,detection and adjustment should be made according to the tolerance of these women for avoiding serious consequences.

关 键 词：妊娠期糖尿病 甲状腺激素替代疗法 甲减 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]