妊娠期甲状腺功能亢进症

Hyperthyroidism in pregnancy:Clinical analysis of 32 cases

目的：探讨甲状腺功能亢进症对妊娠结局、并发症和新生儿的影响。方法：回顾性分析1994年4月-2005年4月解放军总医院收治的32例妊娠合并甲亢的临床资料，根据分娩前血清TSH和FT4是否正常将患者分为甲亢控制组（n=19）和未控制组（n=13），选择同期302例条件匹配的正常妊娠分娩者为正常对照组，比较三组间妊娠结局、并发症和新生儿情况。结果：①妊娠合并甲亢占同期妊娠0．47％（32／6808）；②妊娠期甲亢均采用抗甲状腺药物（ATD）治疗，其中93．33％（14／15）选用丙基硫氧嘧啶（PTU）；③甲亢未控制组早产的发生率显著高于控制组（P〈0．05）；④甲亢控制组妊高症、胎盘早剥和甲亢性心衰的发生率显著低于未控制组，与同期正常对症组相当（P〉0．05）；⑤甲亢未控制组宫内窘迫、低体重儿和死胎明显多于控制组，同时还有1例畸形（梅克尔憩室）。结论：妊娠合并甲亢时应尽可能将甲亢控制满意，以改善妊娠母亲和胎婴儿的预后。

Objective：To investigate the effects of hyperthyroidism on the outcome, complications of pregnancies and the infants. Methods：Retrospective study was performed on the clinical data of 32 pregnant women with hyperthyroidism between 1994 and 2005 in PLA General Hospital. The patients were divided into two groups according to different serum TSH and Fr41ev- els ： well-controlled group and under-controlled group. Other 302 cases of normal pregnancies were chosen as the normal control. Results： The hyperthyroidism during pregnancy occurred in 0.47% of all women with pregnancy. And all the 32 cases were received ATD therapy, and 93.33% （14/15） patients treated with PTU. The incidence of the premature delivery, fetal distress, fatal death and low birth weight infant in under-controlled group were significantly greater than that in well-controlled group （P 〈 0.05）. However, the incidence of the pregnancy-induced hypertension syndrome （ PIH）, placental abruption, and heart failure were lower in well-controlled group. Conclusion： It is vital for pregnant women with hyperthyroidism to well control the hyperthyroidism, so as to improve the outcomes of mothers and neonates.