摘要
目的探讨妊娠期甲状腺功能减退症（SCH）行左旋甲状腺素干预的临床意义。方法选取SCH患者142例，采用随机数字表分为两组，每组各71例，治疗组给予左旋甲状腺素（L-T4）替代治疗，非治疗组不给予药物治疗；另选取同期正常孕妇165例作为对照组，比较三组甲状腺功能、不良妊娠结局及胎儿脐动脉血叶酸和维生素B12水平。结果干预前，治疗组和非治疗组的（TT4）、游离甲状腺素（FT4）水平明显低于对照组，促甲状腺激素（TSH）水平明显高于对照组（P〈0．05），且两者不存在组间差异（P〉0．05）；干预后，治疗组TSH水平明显降低，TT4、FT4水平明显升高，与非治疗组比较，差异有统计学意义（P〈0．05）。治疗组和对照组不良妊娠结局发生率差异无统计学意义（P〉0．05）；非治疗组的不良妊娠结局总发生率高于对照组，差异有统计学意义（P〈0．05），其中差异最为显著的是妊娠期高血压和羊水过少。治疗组和对照组围生儿的脐动脉血叶酸和维生素B12水平均高于非治疗组，差异有统计学意义（P〈0．05）；但治疗组和对照组之间，差异无统计学意义（P〉0．05）。结论及时应用L—T4替代疗法改善SCH甲状腺功能，利于胎儿发育，对预防不良妊娠结局有一定的积极意义。
Objective To explore the clinical application significance of levothyrocine （ L-T4 ） to treat subclinical hypothyroidism （ SCH ） and its effects on the fetal development. Methods 142 patients with SCH were selected and divided into two groups randomly （ n1=n2=71 ） . Patients in the treatment group were given L-T4 replacement therapy, while patients in the non-treatment group given noting. At the same time, 165 normal pregnant women during the same period were selected as the control group. The thyroid function, adverse pregnancy outcomes, and umbilical artery serum levels of folic acid and vitamin B 12 were compared between groups. Result Before intervention, the TT4 and FT4 level of the treatment group and the non-treatment group were lower than those of the control group （ P〈0.05 ） , but there was no significant difference between the treatment group and the non-treatment group （ P〉0.05 ） . After intervention, the TSH level of the treatment group decreased, while TT4 and FT4 level increased, with significant difference compared to the non treatment group （ P〈0.05 ） o There was no significant difference in adverse pregnancy outcomes rate between the treatment group and the control group （ P〉0.05 ） , but the adverse pregnancy outcomes rate of non-treatment group were higher than that of the control group （ P〈0.05 ） , especially gestational hypertension and oligohydramnios. The umbilical artery serum levels of folio acid and vitamin B 12 of the treatment group and the control group were both higher than those of the non-treatment group （ P〈0.05 ） , but there was no significant difference between the treatment group and the control group （ P〉0.05 ） . Conclusions Timely application of L-T4 replacement therapy to improve SCH thyroid fimction is benefitial for fetal development, and has a positive role.for the prevention of adverse pregnancy outcomes.
出处
《浙江临床医学》
2016年第4期654-656,共3页
Zhejiang Clinical Medical Journal
