妊娠期亚临床甲状腺功能减退症应用L—T4治疗探讨(1)
[摘要] 目的 探讨妊娠期亚临床甲状腺功能减退症(SCH)应用左旋甲状腺素(L-T4)的治疗效果。 方法 选取2013年1月～2014年6月本院收治的150例妊娠合并SCH孕妇，根据甲状腺过氧化物酶抗体(TPOAb)检查及是否给予L-T4治疗分为A、B、C三组，A组50例为SCH/TPOAb阳性给予L-T4治疗，B组50例为SCH/TPOAb阴性，给予L-T4治疗，C组为SCH/TPOAb阴性，未给予L-T4治疗，选取同期正常妊娠孕妇50例作为D组。经治疗后比较四组妊娠并发症和胎儿智能发育情况。 结果 C组妊娠并发症发生率为16.00%明显高于A、B、D组，差异有统计学意义(P<0.05)；C组新生儿MDI和PDI评分均低于A、B、D组，差异有统计学意义(P<0.05)。 结论 妊娠期SCH采用L-T4治疗可减少妊娠并发症发生，提高新生儿智能发育，对SCH合并甲状腺过氧化物酶抗体阴性者同样需要治疗。
[关键词] 妊娠；亚临床甲状腺功能减退症；左旋甲状腺素
[中图分类号] R581.2 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0073-03
Clinical effect study of L-thyroxine in the treatment of pregnancy with subclinical hypothyroidism
QIU Hui-ming LIU Xiao-ling LIU Ling CHEN Ying-ting
Department of Adult Internal Medicine，Maternal and Child Health Hospital of Zhuhai City in Guangdong Province，Zhuhai 519000，China
[Abstract] Objective To study the clinical effect of L-thyroxine(L-T4) on pregnancy subclinical hypothyroidism(SCH). Methods 150 pregnancy women with SCH in our hospital from January 2013 to June 2014 were selected and divided into group A，group B，group C according to thyroid peroxidase antibody(TPOAb) test and L-T4 therapy.50 patients in group A was TPOAb positive and treated by L-T4，50 patients in group B were TPOAb negative and treated by L-T4，50 patients in group B were TPOAb negative and was not treated by L-T4.50 healthy pregnant were set as a healthy control(group D).The pregnancy complications and fetal intellectual development situation was compared between four groups respectively. Results The pregnancy complications in group C was 16.0%，which was significantly higher than that in group A，group B and group D(P<0.05).The MDI and PDI in group C were significantly lower than that in group A，group B and group D(P<0.05). Conclusion L-T4 can reduce pregnancy complications and improve fetal intellectual development in the treatment of SCH.SCH patient combined with TPOAb negative also need treatment.
[Key words] Pregnancy；Subclinical hypothyroidism；L-thyroxine
亚临床甲状腺功能减退症(subclinical hypothyroidism，SCH)是指血清促甲状腺激素(TSH)增高，游离甲状腺素(FT4)在正常水平[1]。文献报道妊娠妇女SCH患病率为4%～10%[2]，且有增加的趋势，现已成为妊娠妇女的常见合并症。本次研究探讨妊娠期SCH应用L-T4的治疗效果。
1 资料与方法
1.1 一般资料
选取2013年1月～2014年6月本院收治的150例妊娠合并SCH孕妇为研究对象，根据甲状腺过氧化物酶抗体(TPOAb)检查及是否给予L-T4治疗分为A、B、C三组，A组50例为SCH/TPOAb阳性给予L-T4治疗，B组50例为SCH/TPOAb阴性，给予L-T4治疗，C组为SCH/TPOAb阴性，未给予L-T4治疗，选取同期正常妊娠孕妇50例作为D组。A组患者年龄20～35岁，平均(27.5±2.2)岁，孕周8～12周，平均(10.2±0.5)周；B组患者年龄20～34岁，平均(27.4±2.1)岁，孕周8～12周，平均(10.3±0.6)周；C组患者年龄21～35岁，平均(27.4±2.2)岁，孕周8～12周，平均(10.4±0.6)周；D组年龄20～36岁，平均(27.7±2.6)岁，孕周8～12周，平均(10.7±0.8)周。四组的年龄、孕周等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。所有研究对象签署知情同意书，并自愿参加本次研究。 (邱惠明 刘晓玲 刘玲 陈映婷)
[关键词] 妊娠；亚临床甲状腺功能减退症；左旋甲状腺素
[中图分类号] R581.2 [文献标识码] A [文章编号] 1674-4721(2015)05(b)-0073-03
Clinical effect study of L-thyroxine in the treatment of pregnancy with subclinical hypothyroidism
QIU Hui-ming LIU Xiao-ling LIU Ling CHEN Ying-ting
Department of Adult Internal Medicine，Maternal and Child Health Hospital of Zhuhai City in Guangdong Province，Zhuhai 519000，China
[Abstract] Objective To study the clinical effect of L-thyroxine(L-T4) on pregnancy subclinical hypothyroidism(SCH). Methods 150 pregnancy women with SCH in our hospital from January 2013 to June 2014 were selected and divided into group A，group B，group C according to thyroid peroxidase antibody(TPOAb) test and L-T4 therapy.50 patients in group A was TPOAb positive and treated by L-T4，50 patients in group B were TPOAb negative and treated by L-T4，50 patients in group B were TPOAb negative and was not treated by L-T4.50 healthy pregnant were set as a healthy control(group D).The pregnancy complications and fetal intellectual development situation was compared between four groups respectively. Results The pregnancy complications in group C was 16.0%，which was significantly higher than that in group A，group B and group D(P<0.05).The MDI and PDI in group C were significantly lower than that in group A，group B and group D(P<0.05). Conclusion L-T4 can reduce pregnancy complications and improve fetal intellectual development in the treatment of SCH.SCH patient combined with TPOAb negative also need treatment.
[Key words] Pregnancy；Subclinical hypothyroidism；L-thyroxine
亚临床甲状腺功能减退症(subclinical hypothyroidism，SCH)是指血清促甲状腺激素(TSH)增高，游离甲状腺素(FT4)在正常水平[1]。文献报道妊娠妇女SCH患病率为4%～10%[2]，且有增加的趋势，现已成为妊娠妇女的常见合并症。本次研究探讨妊娠期SCH应用L-T4的治疗效果。
1 资料与方法
1.1 一般资料
选取2013年1月～2014年6月本院收治的150例妊娠合并SCH孕妇为研究对象，根据甲状腺过氧化物酶抗体(TPOAb)检查及是否给予L-T4治疗分为A、B、C三组，A组50例为SCH/TPOAb阳性给予L-T4治疗，B组50例为SCH/TPOAb阴性，给予L-T4治疗，C组为SCH/TPOAb阴性，未给予L-T4治疗，选取同期正常妊娠孕妇50例作为D组。A组患者年龄20～35岁，平均(27.5±2.2)岁，孕周8～12周，平均(10.2±0.5)周；B组患者年龄20～34岁，平均(27.4±2.1)岁，孕周8～12周，平均(10.3±0.6)周；C组患者年龄21～35岁，平均(27.4±2.2)岁，孕周8～12周，平均(10.4±0.6)周；D组年龄20～36岁，平均(27.7±2.6)岁，孕周8～12周，平均(10.7±0.8)周。四组的年龄、孕周等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。所有研究对象签署知情同意书，并自愿参加本次研究。 (邱惠明 刘晓玲 刘玲 陈映婷)