丙基硫氧嘧啶对妊娠合并甲状腺功能亢进孕妇甲状腺功能及妊娠结局影响的观察

Observation of the Effect of Propylthiouracil on the Thyroid Function and Pregnancy Outcome of Pregnant Women with Hyperthyroidism

目的探讨丙基硫氧嘧啶(PTU)影响妊娠合并甲状腺功能亢进(甲亢)孕妇甲状腺功能及妊娠结局的影响。方法选择该院妇产科2007年1月—2012年12月收治的150例妊娠合并甲亢的患者作为观察对象,随机分为观察组78例,对照组72例。观察组予PTU 300 mg/d口服,对照组确诊后未能定期检测甲状腺功能而自行停药,或拒绝PTU药物治疗。结果观察组TT3、TT4、FT3、FT4、TSH水平均显著低于对照组,差异有统计学意义(P<0.05);观察组早产或流产、PTU剖宫产、妊娠高血压、心力衰竭、重度子痫明显低于对照组,而足月产明显高于对照组,差异有统计学意义(P<0.05);观察组的围生儿发生胎儿窘迫、低体重儿、新生儿甲亢、转入NICU发生率均显著低于对照组,两组比较差异有统计学意义(P<0.05)。结论规范的PTU治疗能很好地改善妊娠合并甲亢患者的孕期甲状腺功能,减低甲亢对孕妇及新生儿的危害,改善妊娠结局,且对新生儿畸形率无显著的影响,是一种相对安全和有效的治疗方法。

Objective To investigate the effect of propylthiouracil （PTU） on the thyroid function and pregnancy outcome of preg- nant women with hyperthyroidism. Methods 150 cases of patients with hyperthyroidism during pregnancy admitted in Department of Obstetrics and Gynecology of our hospital from January, 2007 to December, 2012 were selected as the subjects. And they were randomly divided into the observation group of 78 cases and the control group of 72 cases. The observation group was treated with PTU 300 mg per day orally, while the control group failed to regularly test thyroid function after the diagnosis of hyperthyroidism and self-withdrawal or refused the treatment of PTU. Results TT3, TT4, TT3, TT4, TSH levels of the observation group were signif- icantly lower than those of the control group, the differences were statistically significant （P〈0.05）; premature birth or miscarriage, PTU cesarean section, pregnancy-induced hypertension, heart failure, severe preeclampsia in the observation group were signifi- cantly less than those in the control group, but partus matures were much more than those in the control group, the differences were statistically significant （P〈0.05）; the incidences of perinatal child fetal distress, low birth weight children, neonatal hyperthy- roidism and into the NICU of the observation group were significantly lower than those of the control group, the differences were statistically significant （P〈0.05）. Conclusion Standard PTU treatment can greatly improve the thyroid function of patients with hy- perthyroidism during pregnancy, reduce the harm brought by hyperthyroidism on pregnant women and neonates, and improve the pregnancy outcome without significant impact on neonatal malformation, which is a relatively safe and effective treatment.