摘要
目的 探讨左甲状腺素对妊娠合并甲状腺功能减低孕妇妊娠结局及血清人绒毛膜促性腺激素（hCG）、超氧化物歧化酶（SOD）水平的影响.方法 选取东阳市妇女儿童医院2015年12月至2016年10月收治的妊娠合并甲状腺功能减低孕妇86例,按治疗方式不同为观察组41例、对照组45例,对照组进行常规治疗,观察组在对照组基础上加用左甲状腺素钠治疗.观察并比较两组血清促甲状腺激素（TSH）水平,甲状腺素需求量变化,血清hCG、SOD水平,妊娠结局,新生儿生长情况,并发症及临床疗效.结果 孕妇妊娠中期、妊娠末期、产后1周TSH水平分别为（1.85±0.64）mU/L、（1.32±0.36）mU/L、（0.41±0.33）mU/L,均低于妊娠初期的（2.47±0.58）mU/L（t=3.210、8.154、14.479,均P〈0.05）;妊娠中、末期甲状腺素需求量分别为（1.22±0.14）mg·kg-1·d-1、（1.47±0.13）mg·kg-1·d-1,均明显高于妊娠初期的（1.02±0.22）mg·kg-1·d-1（t=3.339、8.531,均P〈0.05）,产后1周的甲状腺素需求量[（1.18±0.15）mg·kg-1·d-1]低于妊娠末期（t=9.202,P〈0.05）;治疗前两组血清hCG、SOD差异均无统计学意义（均P〉0.05）,治疗后对照组血清hCG、SOD分别为（34587.81±8301.72）mU/L、（151.46±24.58）U/mL,观察组分别为（43014.37±7879.43）mU/L、（174.53±31.66）U/mL,两组差异均有统计学意义（t=4.816、3.792,均P〈0.05）;观察组自然分娩率（80.49％）高于对照组（22.22％）,且剖宫产、早期自然流产、先兆子痫、死胎发生率均低于对照组,两组差异均有统计学意义（χ2=29.132、4.051、4.398、5.386、4.836,均P〈0.05）;观察组婴幼儿发育量表（BSID）评分、智能发育指数（MDI）评分、精神运动发育指数（PDI）评分分别为（121.15±8.55）分、（120.89±11.68）分、（118.57±6.52）分,均高于对照组的（103.76±7.49）分、（106.15±9.73）分、（104.14±5.27）分（t=10.052、6.378、11.331,均P〈0.05）;观察组并发症发生率为4.88％,低于对照组的57.78％,观察组有效率为95.12％,明显高于对照组的57.78％,两组差异均有统计学意义（χ2=27.341、16.210,均P〈0.05）.结论 左甲状腺素可以有效提高孕妇血清hCG、SOD水平,改善妊娠合并甲状腺功能减低孕妇妊娠结局,降低并发症发生率,促进新生儿健康生长.
Objective To investigate the effect of L-thyroid hormone on pregnancy outcome,fetal and serum human chorionic gonadotropin（hCG）and superoxide dismutase（SOD）in pregnant women with hypothyroidism.Methods From December 2015 to October 2016,86 pregnant women with hypothyroidism in the Women ＇s and Children＇s Hospital of Dongyang were divided into observation group（n=41）and control group（n=45）according to the treatment method.The control group was treated routinely.The observation group was treated with L-thyroxine sodium tablets on the basis of the control group.The levels of serum thyrotropin（TSH）,thyroxine demand,serum hCG,SOD level,pregnancy outcome,neonatal growth,complications and clinical efficacy were observed and compared.Results The levels of TSH in pregnant women at the second trimester of pregnancy,the end of pregnancy and 1 week after birth were（1.85 ±0.64）mU/L,（1.32 ±0.36）mU/L,（0.41 ±0.33）mU/L,respectively,which was lower than that in the early pregnancy [（2.47 ±0.58）mU/L]（t=3.210,8.154,14.479,all P〈0.05）.At the second trimester of pregnancy and late pregnancy,the thyroid hormone demand was（1.22 ±0.14）mg· kg-1 · d-1,（1.47 ±0.13）mg· kg-1· d-1,respectively,which was significantly higher than that of early pregnancy [（1.02 ± 0.22）mg· kg-1· d-1]（t=3.339,8.531,all P〈0.05）.The thyroxine requirement at 1 week postpartum was（1.18 ± 0.15）mg· kg-1· d-1,which was lower than that at late pregnancy（t=9.202,P〈0.05）.There were no statistically significant differences in serum hCG and SOD between the two groups before treatment（all P〉0.05）.After treatment,the levels of serum hCG and SOD in the control group were（34587.81 ±8301.72）mU/L,（151.46 ±24.58）U/mL,respectively,which in the observation group were（43014.37 ±7879.43）mU/L,（174.53 ±31.66）U/mL,respectively,the differences were statistically significant（t=4.816,3.792,all P〈0.05）.The rate of spontaneous delivery in the observation group（80.49%）was higher than that in the control group（22.22%）,and the incidence rates of cesarean section,early spontaneous abortion,preeclampsia and stillbirth were lower than those in the control group,the differences between the two groups were statistically significant（χ2 =29.132,4.051,4.398,5.386,4.836,all P〈0.05）.The scores of BSID,MDI and PDI of the observation group were（121.15 ±8.55）points,（120.89 ± 11.68）points and（118.57 ±6.52）points,respectively,which were higher than those of the control group [（103.76 ± 7.49）points,（106.15 ±9.73）points,（104.14 ±5.27）points]（t=10.052,6.378,11.331,all P〈0.05）.The incidence rate of complication in the observation group was 4.88%,which was lower than 57.78%in the control group,the effective rate in the observation group was 95.12%,which was significantly higher than that 57.78%in the control group,the differences between the two groups were statistically significant（χ2 =27.341,16.210,all P 〈0.05）.Conclusion L-thyroid hormone can effectively improve the serum hCG and SOD levels in pregnant women,improve the pregnancy outcome of pregnant women with hypothyroidism,reduce the incidence rate of complications and promote the healthy growth of newborns.
作者
吴婷婷
Wu Tingting(Department of Internal Medicine,the Women＇s and Children＇s Hospital of Dongyang,Dongyang,Zhejiang 322100,China)
出处
《中国基层医药》
CAS
2018年第19期2525-2529,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医药卫生计划项目（2011ZDA023）
