不同血清促甲状腺激素水平的妊娠期妇女左甲状腺素治疗剂量分析  

Analysis of the dose of levothyroxine for treatment in pregnant women with different levels of serum thyroid-stimulating hormone

作　　者：白宇[1] 陈奇 厉平[1] 张乐[1] 李玲[1] BAI Yu;CHEN Qi;LI Ping;ZHANG Le;LI Ling(Department of Endocrinology and Metabolism,Shenjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院内分泌科,辽宁沈阳110004

出　　处：《中国实用内科杂志》2021年第7期609-612,共4页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省自然科学基金面上项目(2020-MS-153);中国医科大学附属盛京医院345英才计划。

摘　　要：目的分析不同血清促甲状腺激素(TSH)水平的妊娠期妇女左甲状腺素钠(L-T_(4))的治疗剂量。方法选取2017年9月至2018年6月于中国医科大学附属盛京医院内分泌门诊就诊,参照妊娠和产后甲状腺疾病诊治指南(第2版)中妊娠期甲减及妊娠期亚临床甲减的诊断标准,纳入在妊娠期间首次发现血清TSH升高需应用L-T_(4)治疗且孕期在我院随访的患者共234例。根据妊娠初诊时血清TSH值及初诊时甲状腺过氧化物酶抗体(TPOAb)滴度分为2个亚组,分析各组患者TSH水平达标时L-T_(4)治疗剂量。结果共计234例血清TSH升高的患者,以TSH分组,A组(2.50 mIU/L≤TSH<4.0 m IU/L伴TPOAb阳性)114例,B组(4.0 mIU/L≤TSH<10.0 mIU/L)104例,C组(TSH>10.0 mIU/L)16例。3组TSH水平达标时的L-T_(4)剂量分别为(0.59±0.37)μg/(kg·d),(0.97±0.39)μg/(kg·d),(2.04±0.66)μg/(kg·d),差异有统计学意义(P<0.05)。但根据TPOAb阳性与否的亚组分析显示TPOAb阳性组显著高于TPOAb阴性组,(0.96±0.59)μg/(kg·d)比(0.73±0.45)μg/(kg·d),差异有统计学意义(P<0.05);TPOAb阳性亚组分析中不同TSH组TPOAb阳性和TPOAb阴性患者的L-T_(4)治疗剂量均无明显统计学差异(P>0.05)。多元线性回归分析结果示L-T_(4)剂量与TSH水平及TPOAb有关(β分别为0.581,0.188,P<0.05).结论妊娠期甲状腺功能减退时补充L-T_(4)剂量因TSH升高程度而异,受TPOAb影响。Objective To evaluate the levothyroxine supplementation dosages of pregnant women in the different serum thyroid-stimulating hormone levels. Methods 234 pregnant patients of the outpatient clinic at Shengjing Hospital affiliated to China Medical University were recruited from September 2017 to June 2018. According to the guideline on diagnosis and management of thyroid diseases during pregnancy and postpartum(2 ndedition),they were subgrouped according to the serum TSH and thyroid peroxidase antibody(TPOAb)and given the levothyroxine for treatment when they came firstly. Then the data of each group was analyzed. Results Among the three groups of TSH subgroup,the levothyroxine supplementation of each group was(0.59±0.37)μg/(kg·d),(0.97±0.39)μg/(kg·d),(2.04±0.66)μg/(kg·d),and there were significant differences in the groups(P<0.05). However,subgrouped by the TPOAb,the results showed that the doses of L-T_(4) of the TPOAb positive group were significantly more than the TPOAb negative group,(0.96±0.59)μg/(kg·d)vs.(0.73±0.45)μg/(kg·d)(P<0.05). Evaluated the each TSH group,there were no differences in the doses of L-T_(4) between the TPOAbpositive and TPOAb-negative groups(P>0.05). Multiple linear regression analysis showed LT_(4) supplementation significantly associated with TSH level and TPOAb(r,respectively,0.581,0.188,P<0.05). Conclusion Our data suggested that the doses of LT_(4) were associated with TSH levels in pregnancy and influenced by TPOAb levels.

关 键 词：妊娠期甲状腺功能减退 促甲状腺激素 甲状腺过氧化物酶抗体 左甲状腺素钠 

分 类 号：R581[医药卫生—内分泌]