摘要
目的探讨左旋甲状腺激素替代治疗(L-T4)对妊娠期亚临床甲状腺功能减退(SCH)孕妇血清抵抗素(RE)、同型半胱氨酸(HCY)的影响。方法选取2014年1月-2016年1月该院收治的90例SCH患者,依据随机数字表法将其分为两组:观察组接受L-T4替代治疗,每隔4周复查甲状腺激素(TSH)水平,治疗目标为妊娠早期TSH水平在0.3~2.5 mIU/L,中期和晚期为0.3~3.0 mIU/L,直到治疗达标为止;对照组不接受治疗,每隔4周复查TSH水平。所有患者入院次日及复查TSH当日取空腹肘静脉血,测定血清HCY和RE水平,记录妊娠结局和子代发育12个月的智力情况。结果观察组治疗8周后,血清TSH达到0.3~3.0 m IU/L,达到治疗目标,故将治疗8周的时间点定义为治疗后。观察组治疗后,血清TSH、HCY水平降低(P <0.05),游离甲状腺素(FT4)、RE水平升高(P <0.05),对照组各指标无变化(P>0.05);观察组治疗后的TSH较对照组低(P <0.05),FT4指标较对照组高(P <0.05);观察组不良妊娠结局发生率(10.3%)低于对照组(28.1%)(P <0.05);两组子代发育12个月时的精细动作发育商(FMQ)、大运动发育商(GMQ)、个人社交发育商(ISBQ)及语言发育商(LQ)评分比较,差异均有统计学意义(P <0.05)。结论妊娠早期行左旋甲状腺激素替代治疗有助于降低SCH患者血清TSH、HCY水平,升高抵抗素水平,改善母体状态和妊娠结局,并促进子代智力发育,具有一定的临床意义。
Objective To evaluate application of L-thyroid hormone （L-T4） replacement therapy inpregnant women with subclinical hypothyroidism （SCH）. Methods Totally 90 cases of SCH admitted in our hospital from January 2014 to January 2017 were enrolled and randomly divided into the observation group in which patients were
treated with L-T4, and control group in which no treatment was employed. The goal of TSH level 0.3-3.0 mIU/L.TSH, serum HCY and RE were checked every 4 weeks. Pregnancy outcome and intelligence development at 12nd month were recorded. Results Serum levels of TSH and HCY levels in observation group were decreased （P 〈 0.05）and FT4 and RE levels were increased （P 〈 0.05） significantly post treatment when compared with the same patientprior to any treatments or control group. However no obvious changes were observed in control group. Patients in observation group experienced decreased rate of adverse outcome when compared with control group （P 〈 0.05）.Significant differences of FMQ, GMQ, ISBQ and LQ in two groups were witnessed （P 〈 0.05）. Conclusion L-thyroid hormone replacement therapy is of promising clinical significance.
作者
赵丽杰
郭飒
田兴芳
马庆良
Li-jie Zhao;Sa Guo;Xing-fang Tian;Qing-liang Ma(Department of Gynecology and Obstetrics,Anting Hospital of Shanghai Jiading,Shanghai 201805,China;Department of Gynecology and Obstetrics,Tongji Hospital Affiliated to Shanghai Tongji University,Shanghai 200065,China)
出处
《中国现代医学杂志》
CAS
2018年第30期62-66,共5页
China Journal of Modern Medicine
基金
上海市嘉定区卫计委科研课题(No:2016-KY-11)
