摘要
目的探究左旋甲状腺素钠片治疗不同促甲状腺激素(thyroid stimulating hormone,TSH)水平妊娠合并亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)孕妇的效果及叶酸(folic acid,FA)、同型半胱氨酸(homocysteine,Hcy)及甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)变化和妊娠结局。方法选取152例妊娠合并SCH患者作为研究对象,根据初诊TSH水平分为Ⅰ组(2.5 mIU·L^(−1)<TSH≤4.0 mIU·L^(−1),n=89)和Ⅱ组(TSH>4.0 mIU·L^(−1),n=63),2组均给予左旋甲状腺素钠片(优甲乐)治疗,另选同期80例非SCH孕妇(TSH≤2.5 mIU·L^(−1))作为对照组,追踪随访各组不同孕期孕妇的TSH水平、治疗前后血清生化因子[FA、Hcy、TPOAb和25羟基维生素D(25-hydroxyvitamin D,25-OH-D)]水平变化及不良妊娠结局情况。结果3组年龄、体质量指数(body mass index,BMI)、孕周和产次比较,差异均无统计学意义,血清游离甲状腺素(free thyroxine,FT4)、游离三碘甲腺原氨酸(free triiodothyronine,FT3)水平比较,差异有统计学意义(P<0.05);治疗前Ⅰ组、Ⅱ组血清TSH水平均显著高于对照组(P<0.05);治疗后Ⅰ组、Ⅱ组妊娠27周、36周血清TSH水平均显著降低(P<0.05),且均高于对照组(P<0.05);治疗前,Ⅰ组血清FA、25-OH-D水平均显著高于Ⅱ组(P<0.05),Hcy、TPOAb水平均显著低于Ⅱ组(P<0.05),治疗后,2组血清FA、25-OH-D水平均显著升高(P<0.05),Hcy、TPOAb水平均显著降低(P<0.05),2组FA、25-OH-D、Hcy、TPOAb水平比较差异无统计学意义;3组不良妊娠率分别为6.25%、10.11%、15.87%,差异无统计学意义;多因素Logistic回归分析显示,血清TSH、FT4和TPOAb是妊娠期SCH患者不良妊娠结局的影响因素(P<0.05)。结论左旋甲状腺素钠片治疗不同TSH水平妊娠合并SCH疗效显著,可有效纠正血清生化因子紊乱,改善妊娠结局,其中血清TSH、FT4和TPOAb是妊娠期SCH患者不良妊娠结局的影响因素。
Objective To explore the therapeutic effect of Levothyroxine Sodium Tablets on the changes of folic acid(FA),homocysteine(Hcy),thyroid peroxidase antibody(TPOAb)and pregnancy outcomes in pregnant women with different thyroid stimulating hormone(TSH)levels complicated with subclinical hypothyroidism(SCH)during pregnancy.Methods 152 patients with SCH during pregnancy in the hospital were selected as the research subjects.According to the TSH level at initial diagnosis,the patients were divided into groupⅠ(2.5 mIU·L^(−1)<TSH≤4.0 mIU·L^(−1),n=89)and groupⅡ(TSH>4.0 mIU·L^(−1),n=63).The both groups received Levothyroxine Sodium Tablets(Euthyrox)treatment.80 non-SCH pregnant women(TSH≤2.5 mIU·L^(−1))were enrolled as control group during the same period.The thyroid stimulating hormone(TSH)level during different pregnancy periods,serum biochemical factors[FA,Hcy,TPOAb,and 25-hydroxyvitamin D(25-OH-D)]before and after treatment and adverse pregnancy outcomes were tracked and followed up among the groups.Results There was no statistical difference in age,body mass index(BMI),gestational age and parity among the 3 groups,but there were statistically significant differences in the levels of serum free thyroxine(FT4)and free triiodothyronine(FT3)(P<0.05).Before treatment,the level of serum TSH in groupⅠor groupⅡwas significantly higher than that in control group(P<0.05).The serum TSH levels at weeks 27 and 36 of pregnancy in groupsⅠand groupⅡwere significantly decreased after treatment(P<0.05),and were higher than those in control group(P<0.05).The levels of serum FA and 25-OH-D in groupⅠbefore treatment were significantly higher than those in groupⅡ(P<0.05),while the levels of serum Hcy and TPOAb were significantly lower than those in groupⅡ(P<0.05).After treatment,the serum FA and 25-OH-D were significantly increased(P<0.05),while the Hcy and TPOAb were significantly decreased(P<0.05),but the differences in the above 4 levels were not statistically significant between the 2 groups.The adverse pregnancy rates of the 3 groups were 6.25%,10.11%and 15.87%respectively,without statistical difference.Multivariate Logistic regression analysis showed that the serum TSH,FT4 and TPOAb were the influencing factors of adverse pregnancy outcomes in patients with SCH during pregnancy(P<0.05).Conclusion Levothyroxine Sodium Tablets has a significant efficacy in the treatment of pregnant women with different TSH levels and SCH during pregnancy,and it can effectively correct the disorders of serum biochemical factors and improve the pregnancy outcomes.The serum TSH,FT4 and TPOAb are the influencing factors of adverse pregnancy outcomes in patients with SCH during pregnancy.
作者
许舒晴
冯小凤
姚慧妤
XU Shuqing;FENG Xiaofeng;YAO Huiyu(Department of Gynaecology and Obstetrics,the Affiliated Chuzhou Hospital of Anhui Medical University(The First People’s Hospital of Chuzhou),Chuzhou 239000,China)
出处
《西北药学杂志》
CAS
2024年第2期221-225,共5页
Northwest Pharmaceutical Journal
基金
安徽医科大学校科研基金项目(编号:2021xkj200)。
