摘要
目的探讨中药配合甲状腺激素治疗对妊娠期合并甲状腺功能减退症(简称“甲减”)患者血脂调节效果,以及对母婴健康的影响。方法选取陕西中医药大学第二附属医院2022年7月至2023年6月就诊的98例妊娠期合并甲减患者进行随机对照试验,通过随机数字表法分为对照组和联合组,每组各49例。对照组:年龄27~36(31.67±4.81)岁;入院体重指数(BMI)为(22.43±3.67)kg/m^(2);孕周为(19.09±1.34)周;予低剂量左甲状腺素钠片治疗,初始剂量为25μg/d,每隔4周进行复诊,如促甲状腺激素(TSH)水平未恢复正常,则根据患者耐受程度,依次将剂量调整为50~100μg/d,直到TSH水平恢复正常,共持续治疗12周。联合组:年龄29~39(32.07±5.13)岁;入院BMI为(22.19±3.28)kg/m^(2);孕周为(19.84±1.17)周;在对照组基础上联合补中温阳汤,水煎服,每日1剂,早、晚餐后分2次服用,连续服用12周。通过12周的持续治疗,观察分析两组患者的游离四碘甲状腺原氨酸(FT_(4))、TSH、甲状腺过氧化物酶自身抗体(TPOAb)阳性率、血清总胆固醇(TC)、甘油三酯(TAG)、低密度脂蛋白胆固醇(LDL-C)、母婴结局、新生儿发育水平以及临床总有效率。统计学方法采用t检验、χ^(2)检验。结果联合组临床总有效率高于对照组[85.71%(42/49)比67.35%(33/49)],差异有统计学意义(χ^(2)=4.60,P<0.05)。分娩后,联合组TSH、TPOAb水平、TPOAb阳性率均低于对照组[(1.97±0.46)IU/ml比(2.87±0.62)IU/ml、(8.12±1.47)IU/ml比(10.96±1.82)IU/ml、6.12%(3/49)比20.41%(10/49)],差异均有统计学意义(t=8.16、8.50,χ^(2)=4.35,均P<0.05);联合组血脂水平各项指标均低于对照组,差异均有统计学意义(均P<0.05)。联合组新生儿出生3个月后智力发育指数(MDI)、运动发育指数(PDI)评分均高于对照组[(86.94±5.86)分比(80.27±5.14)分、(85.72±5.15)分比(80.98±5.23)分],差异均有统计学意义(t=5.99、4.52,均P<0.05)。两组不良母婴结局发生率比较[4.08%(2/49)比16.33%(8/49)],差异有统计学意义(χ^(2)=4.01,P<0.05)。结论采用补中温阳汤联合低剂量左甲状腺素钠片治疗妊娠合并甲减患者,可有效改善患者甲状腺功能,降低血脂水平,优化母婴结局,提升新生儿发育水平。
Objective To evaluate the effect of traditional Chinese medicine combined with thyroid hormone on lipid regulation and maternal and neonatal health in pregnant patients with hypothyroidism.Methods Ninety-eight pregnant women with hypothyroidism treated at Second Hospital,Shaanxi University of Traditional Chinese Medicine from July 2022 to June 2023 were selected for the randomized controlled trial,and were divided into a control group and a combination group by the random number table method,with 49 cases in each group.The control group were 27-36(31.67±4.81)years old;their body mass index at admission was(22.43±3.67)kg/m^(2);their gestational age was(19.09±1.34)weeks.The combination group were 29-39(32.07±5.13)years old;their body mass index at admission was(22.19±3.28)kg/m^(2);their gestational age was(19.84±1.17)weeks.Both groups took levothyroxine sodium tablets at an initial dosage of 25μg/d;they revisited every 4 weeks;if their level of thyroid-stimulating hormone(TSH)did not return to normal,they took the tablets 50-100μg/d according to their resistance until their TSH level was normal;they were treated for 12 weeks.In addition,the combination group took Buzhong Wenyang Tang in the morning and at night one dosage per day for 12 weeks.After 12 weeks'treatment,the free thyroxine(FT_(4)),TSH,thyroid peroxidase antibody(TPOAb)positive rates,serum total cholesterol(TC),triglycerides(TAG),low-density lipoprotein cholesterol(LDL-C),maternal and neonatal outcomes,neonatal development[assessed by the Bayley Scales of Infant Development(BSID)],and overall clinical efficacies in both groups were observed and analyzed.t andχ^(2)tests were used.Results The overall clinical efficacy in the combination group was higher than that in the control group[85.71%(42/49)vs.67.35%(33/49)],with a statistical difference(χ^(2)=4.60,P<0.05).After delivery,the levels of TSH and TPOAb and TPOAb positive rate in the combination group were lower than those in the control group[(1.97±0.46)IU/ml vs.(2.87±0.62)IU/ml,(8.12±1.47)IU/ml vs.(10.96±1.82)IU/ml,and 6.12%(3/49)vs.20.41%(10/49)],with statistical differences(t=8.16 and 8.50;χ^(2)=4.35;all P<0.05).After delivery,the levels of TC,TAG,and LDL-C in the combination group were lower than those in the control group,with statistical differences(all P<0.05).Three months after birth,the scores of Mental Developmental Index(MDI)and Psychomotor Developmental Index(PDI)in the combination group were higher than those in the control group[(86.94±5.86)vs.(80.27±5.14)and(85.72±5.15)vs.(80.98±5.23)],with statistical differences(both P<0.05).There was no statistical difference in the incidence of adverse outcomes between the combination group and the control group[4.08%(2/49)vs.16.33%(8/49);χ^(2)=4.01;P<0.05].Conclusion Buzhong Wenyang Tang combined with low-dose levothyroxine sodium for pregnant women with hypothyroidism can effectively improve their thyroid function and neonatal development,lower their lipid levels,optimize maternal and neonatal outcomes.
作者
徐珊
段蓓
张小菜
王敏
宋丽华
Xu Shan;Duan Bei;Zhang Xiaocai;Wang Min;Song Lihua(Department of Obstetrics,Second Hospital,Shaanxi University of Traditional Chinese Medicine,Xixian New Area Central Hospital,Xianyang 712000,China;Fifth Department of Gynecology,Second Hospital,Shaanxi University of Traditional Chinese Medicine,Xixian New Area Central Hospital,Xianyang 712000,China)
出处
《国际医药卫生导报》
2024年第17期2926-2930,共5页
International Medicine and Health Guidance News
基金
陕西省教育厅专项科研计划(20JK0606)。
关键词
甲状腺功能减退症
妊娠期
补中温阳汤
低剂量左甲状腺素钠片
血脂水平
母婴结局
Hypothyroidism
Period of pregnancy
Buzhong Wenyang Tang
Low-dose levothyroxine sodium
Blood lipid levels
Maternal and neonatal outcomes
