激素替代治疗TPOAb阳性TSH≤3.0 mU/L亚临床甲减妊娠早期患者对妊娠结局的影响  

Impact of hormone replacement therapy on the pregnancy outcome of sub-clinical hypothyroidism patients with TPOAb positivity and TSH≤3.0 mU/L in early pregnancy

作　　者：吴邵花 王中芹 王琳[1] WU Shao-hua;WANG Zhong-qin;WANG Lin(Department of Obstetrics and Gynecology,Taizhou People's Hospital Afiliated to Nanjing Med-ical University,Taizhou 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院妇产科,江苏泰州225300

出　　处：《哈尔滨医科大学学报》2024年第6期639-643,共5页Journal of Harbin Medical University

基　　金：江苏省自然科学基金青年基金(BK20201078)。

摘　　要：目的分析激素替代治疗甲状腺过氧化物酶抗体(thyroid peroxidase antibodies,TPOAb)阳性促甲状腺素(thyroid stimulating hormone,TSH)≤3.0 mU/L亚临床甲减妊娠早期患者对妊娠结局的影响。方法选取我院门诊2020年6月~2023年6月TPOAb阳性TSH≤3.0 mU/L亚临床甲减妊娠早期患者92例。根据治疗方法分为对照组40例和观察组52例,观察组口服左甲状腺素钠片50μg/d,对照组口服安慰剂50μg/d。2周复查1次,维持孕期TSH<2.5 mU/L。比较两组的母体血清游离甲状腺素(free thyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、TSH、同型半胱氨酸(homocysteine,Hcy),新生儿FT4、FT3、TSH水平,妊娠结局及分娩结局。结果治疗后,观察组和对照组的TSH分别为(2.16±0.42)mU/L、(2.89±0.37)mU/L,观察组低于对照组(P<0.05);FT4分别为(15.91±1.85)pmol/L、(15.44±2.06)pmol/L,FT3分别为(4.82±0.64)pmol/L、(4.89±0.51)pmol/L,差异无统计学意义(P>0.05)。治疗后,两组患者的Hcy相比治疗前降低(P<0.05)。观察组治疗后Hcy低于对照组(P<0.05)。两组新生儿FT4、FT3比较,差异无统计学意义(P>0.05);观察组新生儿TSH低于对照组(P<0.05)。两组分娩结局比较差异无统计学意义(P>0.05)。观察组和对照组不良妊娠发生率分别为5.77%(3例/52例)、22.50%(9例/40例),观察组低于对照组(P<0.05)。结论激素替代治疗TPOAb阳性TSH≤3.0mU/L亚临床甲减妊娠早期患者,可调节TSH分泌,改善妊娠结局。Objective To analyze the effect of hormone replacement therapy on the pregnancy outcome of patients with subclinical hypothyroidism,TPOAb positivity,and TSH≤3.0 mU/L in early pregnancy.Methods A total of 92 cases of subclinical hypothyroidism with TPOAb positivity and TSH≤3.0 mU/L in early pregnancy were selected.They were divided into a control group of 40 cases and an observation group of 52 cases based on the treatment method.The observation group received oral sodium levothyroxine tablets at a dosage of 50μg/day,while the control group received a placebo at the same dosage.Follow-up examinations were conducted every 2 weeks to maintain TSH levels below 2.5 mU/L during pregnancy.A com-parison was made between the two groups in terms of maternal serum levels of free thyroxine(FT4),free triiodothyronine(FT3),thyroid-stimulating hormone(TSH),homocysteine(Hcy).Additionally,the levels of FT4,FT3,and TSH in newborns,as well as pregnancy outcomes and delivery outcomes were assessed.Results After treatment,the TSH levels in the observation group and the control group were(2.16±0.42)mU/L and(2.89±0.37)mU/L,respectively,with the TSH level in the observation group being lower than that in the control group(P<0.05),the FT4 levels were(15.91±1.85)pmol/L and(15.44±2.06)pmol/L,respectively;and the FT3 levels were(4.82±0.64)pmol/L and(4.89±0.51)pmol/L,with no statistically significant differences(P>0.05).Following treatment,there was a notable reduction in Hcy levels in both patient groups compared with their pre-treatment levels(P<0.05).Additionally,post-treatment,the Hcy levels were significantly lower in the observation group than in the control group(P<0.05).There were no statistically significant differences in the comparison of FT4 and FT3 levels in newborns between the two groups(P>0.05);however,the TSH levels in newborns in the observation group were lower than those in the control group(P<0.05).The difference in delivery outcomes between the two groups was not statistically significant(P>0.05).The rates of

关 键 词：孕早期 亚临床甲减 TPOAb阳性 激素替代 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]