摘要
目的 评估早孕妇女亚临床甲状腺功能减退症（subclinical hypothyroidism,SCH）对妊娠结局的影响及药物治疗的必要性。方法 收集18 243例在厦门大学附属第一医院产前检查直至分娩的病例,诊断标准为妊娠10~12周产前检查时TT4与FT4正常而TSH≥2.5 m IU/L为SCH,甲状腺过氧化物酶抗体（thyroid peroxidase antibody,TPOAb）≥34 U/L为阳性。根据TSH的升高程度不同、TPOAb情况、能否遵医嘱按时按量服用L-T4使TSH控制在正常范围内进行分组：2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阳性且能遵医嘱者为A组,不能遵医嘱者为B组;TSH〉5 m IU/L且TPOAb阳性且能遵医嘱者为C组,不能遵医嘱者为D组;2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阴性且能遵医嘱者为F组,不能遵医嘱者为G组;TSH〉5 m IU/L且TPOAb阴性且能遵医嘱者为H组,不能遵医嘱者为K组。并随机抽取200例同期甲状腺功能正常的病例作为对照组（E组）,回顾分析早孕妇女甲状腺功能异常的发生率、SCH对妊娠结局的影响、早孕妇女SCH行左旋甲状腺素片（L-T4）替代治疗的剂量及影响因素。结果 早孕妇女SCH检出率为5.20%,甲状腺功能正常率为79.00%。A组早产3.31%（8/242）、妊娠期高血压7.02%（17/242）、胎儿生长受限7.02%（17/242）、出生低体质量儿6.61%（16/242）的发生率均低于B组的8.79%（8/91）、14.29%（13/91）、15.38（14/91）、14.29（13/91）（P均〈0.05）;C组自发性流产3.31%（6/181）、早产3.89%（7/181）、妊娠期高血压8.29%（15/181）、妊娠期糖尿病3.89%（7/181）、胎儿生长受限7.73%（14/181）、出生低体质量儿6.63%（12/181）的发生率均低于D组的11.54%（6/52）、11.54%（6/52）、19.23%（10/52）、11.54%（6/52）、17.31（9/52）、15.38（8/52）（P均〈0.05）;A、C、E 3组组间比较,6项指标的发生率差异均无统计学意义。F、G、H、K、E组5组组间比较,6项指标的发生率差异均无统计学意义。A组与C组TSH达标时L-T4使用剂量差异具有统计学意义[（0.757±0.378对1.106±0.454）μg/kg,t=8.39,P〈0.001];F组与H组TSH达标时L-T4使用剂量差异具有统计学意义[（0.443±0.198vs.0.813±0.378）μg/kg,t=8.22,P〈0.001];（A组＋F组）与（C组＋H组）比较,TSH达标时L-T4使用剂量差异具有统计学意义[（0.634±0.358vs.1.017±0.427）μg/kg,t=11.77,P〈0.001]。A组与F组TSH达标时L-T4使用剂量差异具有统计学意义[（0.757±0.378 vs.0.443±0.198）μg/kg,t=9.85,P〈0.001];C组与H组TSH达标时L-T4使用剂量差异具有统计学意义[（1.106±0.454 vs.0.813±0.378）μg/kg,t=5.59,P〈0.001];（A组＋C组）与（F组＋H组）比较,TSH达标时L-T4使用剂量差异具有统计学意义[（0.932±0.463 vs.0.693±0.388）μg/kg,t=6.53,P〈0.001]。结论 早孕妇女SCH且TPOAb阳性可增加自发性流产、早产、妊娠期高血压、妊娠期糖尿病、胎儿生长受限、出生低体质量儿的发生率;L-T4早期干预治疗能有效减少早孕SCH且TPOAb阳性孕妇的妊娠不良反应事件发生率,不能减少早孕SCH且TPOAb阴性孕妇的妊娠不良反应事件发生率;TSH基线水平、TPOAb状况可影响早孕SCH患者L-T4替代治疗的达标剂量。
Objective To assess the influence of subclinical hypothyroidism （SCH） in early pregnant women to the pregnancy outcome and the necessity of drag therapy. Methods Collected 18243 cases that antenatal examination and delivery carried out in the first affiliated hospital of Xiamen university. If the prenatal treatment value of Tl＇4 and VF4 measured in 10-12 weeks were in the normal range and TSH≥2. 5 mIU/L, it judged to be SCH. If the thyroid peroxidase antibody （TPOAb） was equal or greater than 34 U/L, it judged to be positive. The cases were divided into several groups by the increased degree of TSH, TPOAb and the compliance of patients taken L-T4. Grouo A： 2.5 mIU/L≤TSH ≤5.0 mIU/L. TPOAb was positive and had good compliance ; Group B ：2. 5 mIU/L ≤ TSH ≤ 5.0 mIU/L but not have good compliance ; Group C ： TSH 〉 5 mIU/L , TPOAb was positive and had good compliance; Group D： TSH and TPOAb as Group C but not have good compliance; Group F ：2. 5 mIU/L ≤TSH ≤ 5.0 mlU/L, TPOAb was negative and had good compliance; Group G： as Group F, but not have good compliance; Group H： TSH 〉 5 mIU/L, TPOAb was negative and had good compliance ; Group K ： as Group H, but not have good compliance. Randomly selected 200 cases with normal thyroid function at the same period as the control group （Group E）. Retrospective analysis the occurrence rate of thyroid gland dysfunction, the influence of SCH to pregnancy outcome, the doses and influencing factors of replacement therapy by L-T4 to SCH of early pregnant women. Iqosults Relevance ratio of SCH in early pregnant women was 5.20% , the ratio of normal thyroid function was 79.00%. In group A, premature birth 3. 31% （8/242）, gestational hypertension 7.02% （ 17/242）, fetal growth restriction 7.02% （ 17/242）, low birth weight infant 6. 61% （ 16/242）, were lower than that in group B 8.79% （8/91）, 14.29% （ 13/ 91 ）, 15.38 （ 14/91 ）, 14.29 （ 13/91 ） respectively （P 〈 0. 05 ）. In group C, spontaneous abortion 3.31% （6/181）, premature birth 3.89% （7/181）, gestational hypertension 8.29% （ 15/181 ）, gestational diabetes mellitus 3.89% （7/181）, fetal growth restriction 7.73% （ 14/181 ）, low birth weight infant 6. 63% （12/181）, were lower than that in group D 11.54% （6/52）, 11.54% （6/52） ,19.23% （10/52）, 11.54% （6/52）, 17. 31 （9/52）, 15.38 （8/52） （P 〈0. 05）. No significant statistical difference were found in multiple comparison of the above six indexes of group A, B, C. And just the same as the multiple comparison of group F, G, H, K, E. When TSH reach the standard, the dosage of L-T4 in group A and C had significant difference [ （0. 757 ±0. 378vs. 1. 106 ±0. 454） μg/kg,t = 8.39 ,P 〈0. 001 ]. There were also significant differences of group F compared with group H [（0.443±0. 198 vs. 0.813±0.378）μg/kg,t=8.22,P〈0.001], group（A＋F） compared with group （C ＋H） [（0.634±0.358 and 1.017 ± 0. 427 ） μg/kg, t = 11.77, P 〈 0. 001 ], group A compared with group F [ （ 0. 757 ± 0. 378 vs. 0. 443 ± 0. 198 ） μg/kg, t = 9.85, P 〈 0. 001 ], group C compared with group H [ （ 1. 106 ± 0. 45 vs. 0. 813 ± 0. 378 ） μg/kg, t = 5.59, P 〈 0. 001 ], group （ A ＋ C ） compared with group （ F ＋ H） [ （0. 932 ± 0. 463 vs. 0. 693 ±0. 388 ） μg./kg, t = 6.53, P 〈 0. 001 ]. Conclusion The early pregnant women with SCH and TPOAb positive could increase the occurrence rate of spontaneous abortion, premature birth, gestational hypertension, gestational diabetes mellitus, fetal growth restriction and low birth weight infant. The early intervening treatment of L-T4 could efficiently decrease the adverse event occurrence ratio of pregnant woman with SCH and positive TPOAb , but no effect for that with SCH and TPOAb negative. The TSH level and condition of TPOAb could affect the replacement therapy dosage of early pregnancy with SCH.
出处
《中国生化药物杂志》
CAS
2016年第2期172-175,共4页
Chinese Journal of Biochemical Pharmaceutics
关键词
妊娠
SCH
妊娠结局
治疗
pregnancy
SCH
pregnancy outcome
treatment
