不同剂量左甲状腺素治疗妊娠合并甲状腺功能减退症的疗效及安全性评价

Efficacy and Safety Evaluation of Different Doses of Levothyroxine in the Treatment of Pregnancy with Hypothyroidism

目的评析妊娠合并甲状腺功能减退症(以下简称甲减)患者治疗中应用不同剂量左甲状腺素的疗效与安全性差异。方法选取2018年6月至2020年8月在杭州市萧山区第二人民医院经孕检确诊为妊娠合并甲减的160例患者,采用数字随机表法将患者分为A、B两组,各80例。其中A组患者采用小剂量左甲状腺素方案进行治疗,B组则采用大剂量左甲状腺素方案进行治疗。比较两组患者的治疗效果、安全性、妊娠结局和治疗前后甲状腺激素水平、血脂水平。结果两组治疗有效率比较,差异无统计学意义(P>0.05)。A组不良反应发生率低于B组(P<0.05)。两组不良妊娠结局发生率比较,差异无统计学意义(P>0.05)。治疗后A组的游离三碘甲状腺原氨酸(FT_(3))和游离甲状腺素(FT_(4))水平均低于B组,促甲状腺激素(TSH)水平高于B组(P<0.05)。治疗后A组的总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)水平均高于B组(P<0.05)。结论无论是何种剂量的左甲状腺激素在妊娠合并甲减患者治疗中均可取得优质的效果,且对患者的妊娠结局有改善作用,但大剂量给药能进一步改善患者的甲状腺激素水平和血脂水平,小剂量给药则可有效降低药物不良反应,临床治疗时医生应根据患者实际情况进行药物剂量的合理选择,以保障最佳的治疗效果。

Objective To evaluate the efficacy and safety of different doses of levothyroxine in the treatment of pregnant women with hypothyroidism.Methods A total of 160 patients diagnosed with hypothyroidism during pregnancy in the Second People’s Hospital of Xiaoshan District from June 2018 to August 2020 were selected for clinical study.All 160 subjects were divided into experimental group and control group by using the method of digital random table,and 80 patients in each group.Patients in group A were treated with low-dose levothyroxine regimen,and patients in group B were treated with high-dose levothyroxine regimen.This study will compare the effects and significance of different doses of levothyroxine in the treatment of patients with hypothyroidism in pregnancy by comparing the efficacy,safety,pregnancy outcome,thyroid hormone level and blood lipid level before and after treatment between the two groups.Results There was no significant difference in the effective rate between the two groups(P>0.05).The incidence of adverse reactions in group A was lower than that in group B(P<0.05).There was no significant difference in the incidence of adverse pregnancy outcomes between the two groups(P>0.05).After treatment,the levels of FT_(3) and FT_(4) in group A were lower than those in group B,and the level of TSH was higher than that in group B(P<0.05).After treatment,the levels of TC,TG and LDL-C in group A were higher than those in group B(P<0.05).Conclusion No matter what dose of left thyroid hormone is used in the treatment of patients with hypothyroidism in pregnancy,high dose can further improve the level of thyroid hormone and blood lipid in patients,while low dose can effectively reduce adverse drug reactions.In clinical treatment,doctors should make a reasonable choice of drug dose according to the actual situation of patients to ensure the best therapeutic effect.