摘要
目的:探讨妊娠期亚临床甲减甲状腺过氧化物酶抗体(TPOAb)阴性孕妇不同时间左甲状腺素钠片(LT4)治疗对妊娠结局及幼儿远期神经功能的影响。方法:选择2015年2月-2019年6月在本院确诊的亚临床甲减且TPOAb阴性孕妇1158例,根据促甲状腺激素(TSH)水平分为A组477例(2.5 mIU/L<TSH≤4.0 mIU/L)、B组681例(TSH>4.0mIU/L);选择同期TPOAb阴性且甲状腺功能正常妊娠200例为参照组;将A、B组根据是否采用LT4治疗分为A1组257例(LT4干预时间孕<10周),A2组220例(不给予LT4治疗);B1组198例(不给予LT4治疗),B2组154例(LT4干预时间在孕<10周),B3组176例(LT4干预干预时间在孕10~16周),B4组153例(LT4干预时间在孕16~24周);分析各组妊娠结局及其幼儿1.5岁时盖瑟尔智力表评测神经行为与体格功能。结果:A2组、B1组妊娠期糖尿病、早产发生率均高于参照组及A1组、B4、B3、B2组(P<0.05)。各组幼儿体格发育(体重、身长、头围)均无差异(P>0.05)。神经行为能力评分A2组高于B1组,B1组低于参照组(P<0.05);B1组、B2组、B3组、B4组幼儿发育商、应物DQ、言语DQ、应人能DQ有差异(P<0.05);LT4干预时间与发育商、动作DQ、精细动作、应物、应人、言语呈负相关(P<0.05)。结论:LT4干预时间越迟,孕妇妊娠期糖尿病、早产发生率越高,其幼儿神经行为能力损伤越严重。
Objective:To investigate the influence of levothyroxine(LT4)for intervening pregnant women with subclinical hypothyroidism and negative thyroid gland peroxidase antibody(TPOAb)during different gestational weeks on the pregnancy outcomes and the neurological function of infants.Methods:1158 pregnant women with subclinical hypothyroidism and negative TPOAb were enrolled and divided into group A(447 women with 2.5 mIU/L<TSH level≤4.0 mIU/L)and group B(681 women with TSH level>4.0mIU/L)according to the different TSH levels from April 2015 to June 2019.Another 200 pregnant women with TPOAb negative and normal thyroid function were selected in group C.The women in group A were further divided into group A1(257 women with LT4 treatment during less than 10 gestational weeks)and group A2(220 women without LT4 treatment)according to LT4 treatment time.The women in group B were further divided into group B1(198 women without LT4 treatment),group B2(154 women with LT4 treatment during less than 10 gestational weeks),group B3(176 women with LT4 treatment during 10-16 gestational weeks),and group B4(153 women with LT4 treatment during 16-24 gestational weeks).The pregnancy outcomes,and the neurobehavioral and physical function of children with 1.5 years old assessed by Gesell Development Diagnosis Scales were analyzed.Results:The incidences of gestational diabetes mellitus and preterm delivery of the women in groups A2 and B1 were significant higher than those of the women in group C,group A1,group B4,group B3,and group B2(P<0.05).There were no significant differences in the values of physical development indexes(body weight,body length,and head circumference)of the children among these groups(P>0.05).The neurobehavioral ability score of the children in group A2 was significant higher than that of the children in group B1,and which of the children in group B1 was significant lower than that of the children in group C(P<0.05).There were significant differences in infant development quotient,response DQ,language DQ,and social abilities DQ among groups of the children among group B1,group B2,group B3,and group B4(P<0.05).The time of LT4 intervention for pregnant women was negatively correlated with the developmental quotient,the motor ability DQ,fine motor,the response,the social ability,and the language ability of their children(P<0.05).Conclusion:The later intervention time of LT4 for pregnant women is,the higher incidence of gestational diabetes mellitus and premature delivery,and the more severity of neurobehavioral impairment of their infants.
作者
李艳艳
赵旭敏
LI Yanyan;ZHAO Xumin(The First Hospital of Yulin City, Shaanxi Province, 719000)
出处
《中国计划生育学杂志》
2021年第7期1383-1387,共5页
Chinese Journal of Family Planning
关键词
妊娠期亚临床甲减
TPOAb阴性
左甲状腺素钠片
不同时间干预
妊娠结局
幼儿神经功能
Subclinical hypothyroidism and negative TPOAb
Levothyroxine
Intervention during different gestational weeks
Pregnancy outcomes
Neurological function of infant
