不孕女性亚临床甲减患者经L-T4治疗后再移植的临床价值  

The clinical value of retransplantation in infertile women with subclinical hypothyroidism after treatment with L-T4

作　　者：张俊涛 赵夏丽 丁嘉敏 姜根风 胡卫华 ZHANG Jun-tao(Reproductive Medicine Center,The First Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院第一附属医院生殖医学中心,安徽芜湖241000

出　　处：《牡丹江医学院学报》2022年第1期51-54,112,共5页Journal of Mudanjiang Medical University

基　　金：芜湖市科技惠民计划项目(2016hm14)。

摘　　要：目的研究不孕女性亚临床甲减患者经左甲状腺素片(L-T4)治疗后再移植的临床价值,并剖析促甲状腺激素(thyroid stimulating hormone,TSH)水平对其助孕结局的影响。方法回顾性分析2016年1月至2020年8月间,在皖南医学院第一附属医院生殖医学中心行冻胚解冻移植合并亚临床甲减的203名患者的临床数据,根据是否在移植前服用L-T4干预治疗进行分组,未治疗的移植患者作为对照组即A组(TSH≥4.0 mIU/L,n=87),治疗的移植患者作为研究组即B组(TSH<4.0 mIU/L,n=116),比较在此期间两组患者的一般情况、胚胎情况和助孕结局;以TSH值2.5 mIU/L为界,将B组分为B1组(TSH<2.5 mIU/L,n=55)和B2组(2.5 mIU/L≤TSH<4.0 mIU/L,n=61),剖析TSH水平对其助孕结局的影响。结果(1)A组与B组移植患者的年龄、体重指数、基础性激素、移植日内膜厚度、卵裂胚移植率、囊胚移植率、优质胚移植率差异均无统计学意义(P>0.05),但B组的临床妊娠率和分娩率明显高于A组、流产率明显低于A组(P<0.05)。(2)B1组与B2组移植患者的年龄、体重指数、基础性激素、移植日内膜厚度、卵裂胚移植率、囊胚移植率、优质胚移植率差异均无统计学意义(P>0.05),两组的流产率无统计学差异,但B1组的临床妊娠率和分娩率高于B2组,但差异无统计学意义(P>0.05)。结论不孕女性亚临床甲减患者给予L-T4干预治疗后再行冻胚解冻移植,可提高临床妊娠率、分娩率,降低流产率;干预治疗后保持TSH<2.5 mIU/L水平,可能不会显著改变助孕结局,但仍需进一步研究分析。Objective To investigate the clinical value of retransplantation in infertile women with subclinical hypothyroidism after treatment with levothyroxine tablets(L-T4),and to analyze the effect of thyroid stimulating hormone(TSH)level on the outcome of pregnancy.Methods A retrospective analysis was performed on the clinical data of 203 patients who underwent defrosted embryo transplantation combined with subclinical hypothyroidism in Reproductive Medicine Center of the First Affiliated Hospital of Wannan Medical College from January 2016 to August 2020.According to whether to take L-T4 intervention treatment before transplantation,the untreated transplant patients were selected as group A(TSH≥4.0 mIU/L,n=87)and the treated transplant patients were selected as group B(TSH<4.0 mIU/L,n=116).The outcomes of assisted pregnancy(clinical pregnancy rate,miscarriage rate,and delivery rate)were compared between the two groups during this period.The TSH taking value of 2.5 mIU/L as the boundary,group B was divided into group B1(TSH<2.5 mIU/L,n=55)and group B2(2.5 mIU/L≤TSH<4.0 mIU/L,n=61),and the influence of TSH level on the outcome of assisted pregnancy was analyzed.Results(1)There were no significant differences in age,body mass index,basic sex hormones,endometrial thickness on transplantation day,cleavage embryo transfer rate,blastocyst transfer rate,and high-quality embryo transfer rate between the transplanted patients in group A and group B(P>0.05).However,the clinical pregnancy rate and delivery rate of group B were significantly higher than those in group A,and the abortion rate was significantly lower than that in group A(P<0.05).(2)The age,body mass index,basic sex hormones,endometrial thickness on transplantation day,cleavage embryo transfer rate,blastocyst transfer rate,and high-quality embryo transfer rate were not statistically different between group B1 and B2(P>0.05).There was no statistical difference in the abortion rate between the two groups.However,the clinical pregnancy rate and delivery rate of the

关 键 词：亚临床甲状腺功能减退 冻胚解冻移植 促甲状腺激素 左甲状腺素片 助孕结局 

分 类 号：R715.5[医药卫生—妇产科学]