不同剂量左甲状腺素钠对妊娠期糖尿病并发甲状腺功能减退症患者疗效及产后甲状腺功能转归的影响  

Effects of different doses of levothyroxine sodium on the efficacy and postpartum thyroid function in patients with gestational diabetes mellitus complicated by hypothyroidism

作　　者：尹苗霞 胡小迪 张早花 林向容[1] YIN Miao-xia;HU Xiao-di;ZHANG Zao-hua;LIN Xiang-rong(Department of Obstetrics,Longgang Central Hospital,Shenzhen 518116,Guangdong,China)

机构地区：[1]深圳市龙岗中心医院产科,广东深圳518116

出　　处：《川北医学院学报》2024年第11期1507-1511,共5页Journal of North Sichuan Medical College

基　　金：广东省基础与应用基础研究基金项目(2021A1515012549)。

摘　　要：目的:探讨不同剂量左甲状腺素钠对妊娠期糖尿病(GDM)并发甲状腺功能减退症患者疗效及产后甲状腺功能转归的影响。方法:取120例妊娠期GDM并发甲状腺功能减退症患者为研究对象,按照给药剂量不同分为高剂量组、中剂量组、低剂量组,每组各40例。各组均给予左甲状腺素钠结合二甲双胍治疗,低剂量组左甲状腺素钠起始剂量25μg/d,两周后增加至50μg/d;中剂量组起始剂量50μg/d,两周后增加至100μg/d;高剂量组起始剂量75μg/d,两周后增加至150μg/d,持续治疗至分娩。比较各组患者甲状腺功能、糖脂代谢水平、妊娠结局、新生儿神经心理发育水平差异、产后甲状腺功能转归以及用药期间不良反应发生率。结果:各组患者治疗6周后游离三碘甲状腺原氨酸(FT_(3))、游离四碘甲状腺原氨酸(FT_(4))水平比较:为高剂量组>中剂量组>低剂量组(P<0.05);促甲状腺激素(TSH)水平比较:高剂量组<中剂量组<低剂量组(P<0.05);各组患者治疗6周后外周血空腹血糖(FPG)、糖化血红蛋白(HbAlC)、甘油三酯(TG)、胆固醇(TC)水平比较:高剂量组<中剂量组<低剂量组(P<0.05);高剂量组不良妊娠结局发生率10.00%,分别低于中剂量组27.50%(P<0.05)、低剂量组37.50%(P<0.05);各组新生儿出生6个月后神经心理发育水平比较,差异均无统计学意义(P>0.05);随访产后患者甲状腺功能转归,高剂量组产后1个月甲状腺功能减退发生率为22.50%,分别低于中剂量组45.00%和低剂量组47.50%(P<0.05);产后3个月、6个月时,各组患者甲状腺功能减退发生率比较,差异均无统计学意义(P>0.05);高剂量组不良反应发生率20.00%高于低剂量组2.50%(P<0.05)。结论:左甲状腺素钠高剂量给药结合二甲双胍治疗GDM并发甲状腺功能减退症可取得较佳的甲状腺功能和糖脂代谢调节效果,有利于患者妊娠结局改善,促进产后甲状腺功能恢复,但也在一定程度上增加了不良反应�Objective:To investigate the effects of different doses of levothyroxine sodium on the efficacy and postpartum thyroid function in patients with gestational diabetes mellitus(GDM)complicated by hypothyroidism.Methods:A total of 120 patients with GDM complicated by hypothyroidism were divided into three groups using dosage administered:high-dose group,medium-dose group,and low-dose group,with 40 patients in each group.All three groups were treated with levothyroxine sodium in combination with metformin.The initial dose of levothyroxine sodium was 25μg/d in the low-dose group,increased to 50μg/d after 2 weeks,50μg/d in the medium-dose group,increased to 100μg/d after 2 weeks,and 75μg/d in the high-dose group,increased to 150μg/d after 2 weeks.Treatment continued until delivery.Thyroid function,glucose and lipid metabolism levels,pregnancy outcomes,neonatal neuropsychological development levels,postpartum thyroid function,and adverse reactions during medication were compared among the three groups.Results:After 6 weeks of treatment,levels of free triiodothyronine(FT_(3))and free thyroxine(FT_(4))were highest in the high-dose group,followed by the medium-dose group,and lowest in the low-dose group,while thyroid-stimulating hormone(TSH)levels were lowest in the high-dose group,followed by the medium-dose group,and highest in the low-dose group(P<0.05).Levels of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),triglycerides(TG),and total cholesterol(TC)in peripheral blood were lowest in the high-dose group,followed by the medium-dose group,and highest in the low-dose group after 6 weeks of treatment(P<0.05).The incidence of adverse pregnancy outcomes was 10.00%in the high-dose group,which was lower than 27.50%in the medium-dose group and 37.50%in the low-dose group(P<0.05).There were no significant differences in neonatal neuropsychological development levels among the three groups at 6 months after birth(P>0.05).Postpartum thyroid function follow-up showed that the incidence of hypothyroidism at 1 mont

关 键 词：妊娠期糖尿病 甲状腺功能减退症 二甲双胍 左甲状腺素钠 甲状腺功能 

分 类 号：R714.256[医药卫生—妇产科学] R581.2[医药卫生—临床医学]