妊娠妇女亚临床甲状腺功能减退症对妊娠结局的影响

Impact of subclinical hypothyroidism on the outcome of pregnancy

目的 评估妊娠妇女亚临床甲状腺功能减退症（SCH）对妊娠结局的影响及药物干预治疗后妊娠结局的改变情况.方法 选取1 786名早期妊娠妇女,于妊娠早、中、晚期测定其血清游离甲状腺素（FT4）、总甲状腺素（TT4）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体水平,对妊娠早期检出的123例SCH孕妇以随机数字表法随机分成治疗组（42例）和非治疗组（81例）.治疗组参照美国甲状腺学会推荐的方案给予左旋甲状腺素（L-T4）治疗,复查甲状腺功能.追踪随访所有孕妇的妊娠结局及产科并发症发生情况,进行统计分析.结果 （1） SCH组与对照组比较：妊娠早期SCH妇女自发性流产发生率升高（20.99％对8.45％,x2=12.96,P=0.00）;妊娠中期SCH妇女妊娠期糖尿病发生率升高（24.69％对10.45％,x2=14.11,P=0.00）;而在妊娠期高血压、早产、胎盘早剥、前置胎盘、胎儿生长受限、出生低体重的发生率上差异均无统计学意义（均P＞0.05）.（2）治疗组与非治疗组比较：自发性流产发生率（7.14％对20.99％,x2=3.89,P=0.05）、妊娠期糖尿病发生率（9.52％对24.69％,x2 =4.05,P=0.04）均下降,而在妊娠期高血压、早产、胎盘早剥、前置胎盘、胎儿生长受限、出生低体重的发生率上差异均无统计学意义（均P＞0.05）.结论 妊娠早期SCH是自发性流产的危险因素;妊娠中期SCH是妊娠期糖尿病的危险因素;妊娠期SCH经L-T4干预治疗可使临床获益.

Objective To evaluate the impact of subclinical hypothyroidism （SCH） on the outcome of pregnancy and the therapeutic effect of L-T4.Methods A total of 1 786 pregnant women during the first, second, and third trimesters were enrolled for thyroid screening by determining serum free thyroxine （FT4）, total thyroxine （TT4）, thyrotropin （TSH）, and thyroid peroxidase antibody;123 pregnant women with SCH were successfully divided into treated group （n =42） and untreated group （n =81）.The treated group was treated by L-T4 based on American Thyroid Association （ATA） 2011 guideline.Collected items include obstetric outcomes and complications.Results （1） Compared to control group, the rate of spontaneous abortion in pregnant women during first trimesters was increased in SCH group （20.99% vs 8.45%, x2 =12.96, P =0.00）, with higher incidence of diabetes during second trimester （24.69% vs 10.45%, x2 =14.11, P =0.00）.The incidences of hypertension during pregnancy, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight showed no difference between two groups （all P 〉 0.05）.（2） Compared with the untreated group, the incidences of spontaneous abortion and diabetes were decreased in the treated group （7.14% vs 20.99%, x2 =3.89, P =0.05;9.52% vs 24.69%, x2 =4.05, P =0.04）, while the incidences of hypertension, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight infant accident rate were not different between two groups （all P 〉 0.05）.Conclusions SCH during the frist trimester is a risk factor of spontaneous abortion;SCH during the middle stage of pregnancy is a risk factor of gestational diabetes mellitus.Treatment of SCH with L-T4 may be beneficial.