摘要
目的观察左甲状腺素钠片治疗甲状腺抗体阴性妊娠期亚临床甲状腺功能减退症(SCH)孕妇的疗效及其对妊娠结局的影响.方法回顾性分析邛崃市医疗中心医院妇产科2016年7月~2018年7月间妊娠合并甲状腺过氧化物抗体(TPOAb)与甲状腺球蛋白抗体(TgAb)阴性SCH孕妇的病例,从确诊后采用左甲状腺素钠片治疗以及确诊后不予以治疗的孕妇中各随机抽取50例病例资料,分别纳入SCH治疗组和SCH未治疗组;另抽取同时间段在我院行体检的50例正常健康孕妇的病例资料列为健康对照组.比较SCH治疗组治疗前、治疗4周后,与健康对照组患者的血清叶酸水平、甲状腺功能相关指标[血清促甲状腺素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)]水平,分析三组孕妇妊娠结局(顺产率、早产、流产、宫内窘迫、胎儿畸形发生率)、新生儿甲状腺功能指标(TSH、FT3、FT4)水平及身长、体重、1min新生儿评分(Apgar)结果差异.结果治疗4周后,SCH治疗组血清叶酸水平较治疗前明显升高(P均<0.05),但低于健康对照组(P均<0.05);血清TSH较治疗前明显降低(P<0.05),但高于健康对照组(P<0.05);血清FT3、FT4较同组治疗前及健康对照组差异均无统计学意义(P均>0.05).SCH治疗组顺产率、新生儿体重均明显高于SCH未治疗组(P均<0.05),早产、流产发生率、血清TSH水平均明显低于SCH未治疗组(P均<0.05),且以上指标与健康对照组差异均无统计学意义(P均>0.05).三组宫内窘迫、胎儿畸形发生率及新生儿身长、Apgar评分、血清FT3、FT4水平差异均无统计学意义(P均>0.05).结论左甲状腺素钠片用于妊娠期SCH患者的治疗,可调节孕妇甲状腺功能并改善妊娠结局,利于胎儿的健康成长和发育.
Objective To observe the efficacy of levothyroxine sodium tablets in the treatment of pregnant women with subclinical hypothyroidism(SCH) of negative thyroid antibodies during pregnancy and its effects on pregnancy outcomes. Methods The data of pregnant women with pregnancy and SCH of negative thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) in the Department of Obstetrics and Gynecology of Qionglai Medical Center Hospital from July 2016 to July 2018 were retrospectively analyzed. 50 pregnant women with levothyroxine sodium tablets after diagnosis and 50 pregnant women without treatment after diagnosis were randomly selected and included in SCH treated group and SCH untreated group. The data of another 50 normal healthy pregnant women examined at the same time in our hospital were listed as healthy control group. The levels of serum folic acid and related indicators of thyroid function [serum thyroid stimulating hormone(TSH), free triiodothyronine(FT3), free thyroxine(FT4)]were compared before treatment and after 4 w of treatment between SCH treated group and healthy control group. The pregnancy outcomes of pregnant women(shun yield, incidence rates of premature birth, abortion, intrauterine distress and fetal malformation), neonatal thyroid function indicators(TSH, FT3, FT4) and height, weight and 1 min neonatal Apgar score were analyzed among the three groups. Results After 4 w of treatment, serum folic acid level in SCH treated group was significantly higher than that before treatment(all P<0.05), but was lower than that in healthy control group(all P<0.05). The serum TSH was significantly lower than that before treatment(P<0.05), but was higher than that in healthy control group(P<0.05). There were no significant differences in the serum FT3 and FT4 compared with the same group before treatment and healthy control group(all P>0.05). The shun yield and neonatal weight in SCH treated group were significantly higher than those in SCH untreated group(all P<0.05), and the incidence rates of premature birth and abortion and the serum TSH level were significantly lower than those in SCH untreated group(all P<0.05), and there were no significant differences in the indexes compared with those in healthy control group(all P>0.05). There were no significant differences in the incidence rates of intrauterine distress and fetal malformation, neonatal height, Apgar score and serum FT3 and FT4 levels(all P>0.05). Conclusions Levothyroxine sodium tablets for patients with SCH during pregnancy can regulate the thyroid function of pregnant women and improve the pregnancy outcomes, and it is conducive to the healthy growth and development of fetuses.
作者
黄家斌
李志辉
张琼
李贵全
吴本华
HUANG Jiabin;LI Zhihui;ZHANG Qiong;LI Guiquan;WU Benhua(Department of Thyroid Surgery, West China Hospital, Sichuan University,Chengdu 610041,China;Qionglai Medical Center Hospital,Qionglai 611530,Sichuan,China)
出处
《西部医学》
2019年第6期913-916,921,共5页
Medical Journal of West China
基金
四川省医学会科研项目(Q1500322)
关键词
左甲状腺素钠片
妊娠
SCH
临床疗效
妊娠结局
Levothyroxine sodium tablets
Pregnancy
SCH
Clinical efficacy
Pregnancy outcomes
