摘要
目的探讨妊娠早期新发现的甲状腺功能减退(简称甲减)和亚临床甲减患者最佳的左甲状腺素钠剂量,并比较之间的区别。方法回顾性分析2019-09-01-2020-08-31临沂市妇幼保健院门诊就诊的妊娠早期孕妇中初次被诊断为甲减的937例患者的临床资料。采用《妊娠和产后甲状腺疾病诊治指南(第2版)》中标准将上述患者分为妊娠期亚临床甲减组(1组,n=860)和临床甲减组(2组,n=77)。1组根据促甲状腺激素(TSH)的不同分为3个亚组:4.0 mIU/L<TSH≤5.0 mIU/L为1a组(n=497),5.0 mIU/L<TSH≤8.0 mIU/L为1b组(n=329),TSH>8.0 mIU/L为1c组(n=34)。2组根据TSH不同分为2个亚组:4.0 mIU/L<TSH≤10.0 mIU/L为2a组(n=59),TSH>10.0 mIU/L为2b组(n=18)。所有患者一旦诊断后尽快给予左甲状腺素钠治疗。3周后第1次复查就能使TSH在0.1~2.5 mIU/L的剂量被认为是最佳剂量。结果1组和2组所需的最佳左甲状腺素钠剂量分别为(1.58±0.36)和(2.00±0.30)μg/(kg·d),差异有统计学意义,t=-11.759,P<0.001。亚临床甲减的1a组所需最佳左甲状腺素钠剂量为(1.50±0.35)μg/(kg·d),1b组为(1.67±0.33)μg/(kg·d),1c组为(1.83±0.34)μg/(kg·d),3组间比较差异有统计学意义,F=34.949,P<0.001;两两比较差异均有统计学意义:1a与1b组比较,t=-7.128,P<0.001;1a与1c组比较,t=-5.320,P<0.001;1b与1c组比较,t=-2.634,P=0.009。2a组所需的最佳剂量为(2.00±0.31)μg/(kg·d),与2b组的(2.00±0.25)μg/(kg·d)比较,差异无统计学意义,t=-0.065,P=0.949。结论妊娠早期新诊断的临床甲减孕妇初始最佳左甲状腺素钠剂量为(2.00±0.30)μg/(kg·d);亚临床甲减孕妇初始最佳剂量需要根据TSH的不同而适当调整。
Objective To explore the best dose of levothyroxine sodium in patients with newly discovered hypothyroidism and subclinical hypothyroidism in early pregnancy,and compare the differences between them.Methods The clinical data of 937 cases of hypothyroidism diagnosed for the first time in the first trimester of pregnancy in the outpatient service of Women and Children’s Health Care Hospital of Linyi from September 1,2019 to August 31,2020 were analyzed retrospectively.The above patients were divided into subclinical hypothyroidism group(group 1,n=860 cases)and clinical hypothyroidism group(group 2,n=77 cases)during pregnancy according to the criteria in the Guidelines for the Diagnosis and Treatment of Thyroid Diseases in Pregnancy and Postpartum(Version 2).Group 1 was divided into three subgroups according to the difference of thyroid stimulating hormone(TSH):4.0 mIU/L8.0 mIU/L was group 1c(n=34).The two groups were divided into two subgroups according to different TSH:4.0 mIU/L10.0 mIU/L was group 2b(n=18).All patients were treated with levothyroxine sodium as soon as possible after diagnosis.The first reexamination after 3 weeks could make the dose of TSH between 0.1 and 2.5 mIU/L be considered as the best dose.Results The optimal dose of levothyroxine sodium required for group 1 and group 2 was(1.58±0.36)and(2.00±0.30)μg/(kg·d),respectively,the difference was statistically significant,t=-11.759,P<0.001.The optimal dose of levothyroxine sodium required for subclinical hypothyroidism group 1a was(1.50±0.35)μg/(kg·d),group 1b was(1.67±0.33)μg/(kg·d),1c group was(1.83±0.34)μg/(kg·d),the difference between the three groups was statistically significant,F=34.949,P<0.001.The difference between the two groups was statistically significant:compared with group 1aand 1b(t=-7.128,P<0.001),compared with group 1aand 1c(t=-5.320,P<0.001),compared with group 1band 1c(t=-2.634,P=0.009).The best dose required for group2awas(2.00±0.31)μg/(kg·d),compared with group 2b(2.00±0.25)μg/(kg·d),the difference was not statistically significant,t=-0.065,P=0.949.Conclusions The initial optimal dose of levothyroxine sodium for newly diagnosed clinical hypothyroidism in early pregnancy is(2.00±0.30)μg/(kg·d).The initial optimal dose of subclinical hypothyroidism pregnant women needs to be adjusted according to the different TSH.
作者
高庆
张荣航
李欣
GAO Qing;ZHANG Rong-hang;LI Xin(Women and Children's Health Care Hospital of Linyi,Linyi 276000,China)
出处
《社区医学杂志》
CAS
2023年第1期26-29,共4页
Journal Of Community Medicine
基金
临沂市科技创新发展计划(医学类)基金(201919043)
关键词
妊娠早期
甲状腺功能减退
左甲状腺素钠
促甲状腺激素
early trimester of pregnancy
hypothyroidism
levothyroxine sodium
thyroid stimulating hormone
