摘要
目的:探讨不同治疗剂量左旋甲状腺素(L-T4)对妊娠合并亚临床性甲状腺功能减退症(亚甲减)患者甲状腺功能、叶酸水平及母婴结局的影响。方法:将安阳市第六人民医2018年7月—2020年9月收治的93例妊娠合并亚甲减孕妇作为研究对象,按照随机数字表法分为对照组和观察组。依据患者血清促甲状腺激素(TSH)水平(<8.00mU/L,8.01~10.00mU/L,>10.00mU/L),对照组46例分别给予小剂量(50、75、100μg/d)的L-T4治疗,观察组47例给予大剂量(75、100、125μg/d)L-T4治疗,比较两组患者治疗前和分娩后血清TSH、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和叶酸水平,新生儿发育水平,妊娠结局,不良反应发生情况。结果:两组治疗前、分娩后FT3、FT4水平差异无统计学意义(P>0.05);两组分娩后TSH水平较治疗前降低,观察组较对照组更低;叶酸水平较治疗前升高,观察组较对照组更高(P<0.05)。观察组出生6个月后的新生儿智能发育指数(MDI)、运动发育指数(PDI)评分较对照组高(P<0.05)。观察组的剖宫产率(6.38%,3/47例)低于对照组(15.22%,7/46例),不良母婴结局发生率(10.64%,5/47例)低于对照组(23.91%,11/46例),不良反应发生率(8.51%,4/47例)高于对照组(4.35%,2/46例),但差异均无统计学差异(P>0.05)。结论:使用大剂量L-T4治疗妊娠合并亚甲减孕妇,可调节血清TSH、FT3、FT4、叶酸水平,最终调控母婴结局,改善新生儿发育水平,有较好的安全性。
Objective: To explore the effects of different doses of levothyroxine(L-T4) on thyroid function, folic acid level and maternal and infant outcomes in pregnant women with subclinical hypothyroidism(subhypothyroidism).Methods: Ninety-three pregnant patients with subhypothyroidism in our hospital from Jul. 2018 to Sept. 2020 were selected as the research objects, and were divided into control group and observation group according to random number table method. According to the level of serum thyroid stimulating hormone(TSH<8.00 mU/L, 8.01-10.00 mU/L, >10.00 mU/L), 2 groups were treated with different doses of levothyroxine tablets orally, 46 patients in control group were treated with low doses of L-T4(50, 75, 100 μg/d). Forty-seven patients in observation group were treated with L-T4 with high dose(75, 100, 125 μg/d), and the levels of serum TSH, free triiodothyronine(FT3), free thyroxine(FT4) and folic acid, neonatal development level, pregnancy outcome and adverse reactions before treatment and after delivery were compared between the two groups. Results: There was no significant difference in FT3 and FT4 levels between the two groups before treatment and after delivery(P>0.05). The TSH level of the two groups after delivery was lower than that before treatment, and the observation group was lower than the control group. Folic acid level in observation group was higher than that in control group(P<0.05). The scores of mental development index(MDI) and psychomotor development index(PDI) in the observation group were higher than those in the control group after 6 months of birth(P<0.05). The rate of cesarean section in observation group(6.38%, 3/47 cases) was lower than that in control group(15.22%, 7/46 cases), and the incidence of adverse maternal and infant outcomes(10.64%, 5/47 cases) was lower than that in control group(23.91%, 11/46 cases), and the incidence of adverse reactions(8.51%, 4/47 cases) was higher than that in control group(4.35%, 2/46 cases), but there was no significant difference(P>0.05). Conclusions: The use of large dose of L-T4 in the treatment of pregnancy patients with subhypothyroidism can regulate the levels of serum TSH, FT3, FT4 and folic acid, and ultimately regulate maternal and infant outcomes, improve the development level of neonates, and has a good safety.
作者
宋海青
尹妮
Song Haiqing;Yin Ni(The Second Obstetric District of Anyang Sixth People’s Hospital,Anyang,Henan 455000,China)
出处
《感染．炎症．修复》
2021年第3期158-161,共4页
Infection Inflammation Repair
