左旋甲状腺素对亚临床甲状腺功能减退症妊娠的影响

Influence of L-thyroxine tablets on subclinical hypothyroidism pregnancy

目的：探讨左旋甲状腺素干预对孕期亚临床甲状腺功能减退症（SCH）患者妊娠的影响。方法：回顾性分析2010年l～12月在北京妇产医院妊娠合并SCH分娩孕妇143例，其中经左旋甲状腺素（L—T4）替代治疗后64例（治疗组），未进行药物干预治疗的79例（未治疗组），随机选取同期分娩的正常孕妇252例作为对照组，分析三组孕妇的妊娠结局及血脂代谢情况。结果：未服药的SCH孕妇与甲状腺功能正常的孕妇比较，其在早产、妊娠高血压、子痫前期、胎盘早剥及甘油三酯异常的发生率明显增高；未服药的SCH与服药者比较，其在早产、子痫前期、胎盘早剥及甘油三酯异常的发生率上的差异具有统计学意义；服药的SCH孕妇与甲状腺功能正常的孕妇比较，在早产、妊娠高血压、子痫前期、胎盘早剥及甘油三酯异常的发生率的差异无统计学意义。结论：亚临床甲减使妊娠妇女不良妊娠结局增加；早期应用左甲状腺素替代治疗后，患者的妊娠结局改善及血脂异常状况均得到不同程度的改善。

Objective： To investigate the influence of L-thyroxine tablets on subclinical hypothyroidism pregnancy. Method： A total of 143 pregnant women with SCH were analyzed retrospectively in the period of January to December, 2010 in our hospital. 64 of 143 were given L-thyroxine tablets （L-T4） replacement therapy （L-T4 group） and the remaining 79 were not given any drugs （no treatment group）. At the same time, 252 pregnant women with normal thyroid function, who were in the similar pregnant period, were assigned to the control group. The pregnancy outcomes and metabolism of lipid of the three groups were observed. Result： Incidences of premature birth, gestational hypertension, preeclampsia, placental abruption and abnorma triglyceride were Higher in the no treatment group than in the control group （ P 〈0.05）. The rates of premature birth gestational hypertension, preeclampsia, placental abruption and abnormal triglyceride between the no treatment group and the L-T4 group were obviously different （ P 〈0.05）. The difference of incidence for premature birth, gestational hypertension preeclampsia, placental abruption and abnormal triglyceride between the L-T4 group and the control group was immateria （P 〉0.05）. Conclusion： Subclinical hypothyroidism relates to the increased incidences of abnormal pregnancy outcome. Early L-thyroxine tablets （L-T4） replacement therapy can result in diverse improvements on abnormal pregnancy outcome and metabolic abnormality of lipid.