临床干预对亚临床甲状腺功能减退合并不孕与自然流产患者妊娠结局的影响

Clinical intervention and pregnancy outcome study of subclinical hypothyroidism combining with infertility or spontaneous miscarriage

目的探讨亚临床甲状腺功能减退症合并不孕与自然流产史患者给予左甲状腺素钠（L-T4）干预治疗对改善妊娠结局的临床效果。方法选择2012年1月-2015年1月在我院生殖医学科门诊就诊的不孕症和有自然流产史合并亚临床甲状腺功能减退的患者60例为研究对象,根据患者愿意及要求,将其分为研究组和对照组,各30例。研究组用左甲状腺素钠,口服治疗,对照组未干预,观察两组患者的妊娠率、流产率等情况。结果研究组患者的妊娠率为26.67%、流产率为12.5%,对照组患者的妊娠率为10%、流产率为66.67%,两组患者妊娠率比较差异有统计学意义（P〈0.05）,流产率比较差异有统计学意义（P〈0.01）;研究组治疗前与治疗后TSH比较,差异有统计学意义（P〈0.05）。结论对亚临床甲状腺功能减退合并不孕和自然流产患者给予左甲状腺素钠干预治疗,可明显改善甲状腺功能,提高妊娠率,降低流产率,从而改善妊娠结局。

Objective To explore the clinical effect of clinical intervention for subclinical hypothyroidism combined with infertility patients with natural abortion and pregnancy outcome. Methods From January 2012 to January 2015,60 subclinical hypothyroidism patients with infertility or spontaneous miscarriage visited our outpatient clinic of reproductive medicine department were selected as research objects.Based on patient′s will and requirements,they were evenly divided into research group and control group,with 30 cases in each group.In the research group,oral administration of levothyroxine was provided,while in the control group,no intervention was applied.The pregnancy rate and miscarriage rate in the both groups were observed. Results The pregnancy rate and miscarriage rate in the research group was26.67% and 12.5% respectively,while they were 10% and 66.67% in the control group.There was statistical difference in comparison of pregnancy rate（P〈0.05） and miscarriage rate（P〈0.01） in the two groups.There was statistical difference of TSH after treatment in research group（P〈0.05）. Conclusion For patients with subclinical hypothyroidism and infertility or spontaneous miscarriage,application of levothyroxine as an intervention can greatly improve thyroid function, pregnancy rate,and decrease miscarriage rate,and finally improve pregnancy outcomes.