不同时期妊娠甲状腺功能减退症孕妇左甲状腺素钠治疗达标剂量观察

Study on levothyroxine substitutive therapy for women with hypothyroidism during different periods of pregnancy

目的探讨不同时期妊娠甲状腺功能减退症(HT)孕妇采用左甲状腺素钠(L-T4)治疗的达标剂量及治疗效果。方法选择2013年1月至2014年12月来我院进行围产期保健的不同孕期的原发性甲状腺功能减退症孕妇120例,根据患者使用L-T4治疗剂量的不同,分为A组和B组,每组60例。比较两组患者妊娠12、27、36周的妊娠期甲状腺素变化、L-T4饱和剂量达标情况和妊娠结局情况。结果妊娠12周时,两组TSH水平比较差异无统计学意义(P>0.05)。妊娠27、36周时,两组TSH水平比较差异有统计学意义(P<0.05)。妊娠12、27、36周时,两组治疗后妊娠各期TSH水平均达到治疗目标。两组患者妊娠12、27、36周时,L-T4达到饱和剂量例数比较,差异无统计学意义(P>0.05)。妊娠12、27、36周时,两组患者L-T4饱和剂量比较,差异有统计学意义(P<0.05)。结论对于妊娠期HT患者的治疗需正确引导,及时监测,调整剂量,根据患者妊娠不同时期的自身需求进行治疗,可获得较好的临床效果,且妊娠不良结局的发生率较低。

Objective To investigate the standard dose and effects of levothyroxine（L-T4） substitutive therapy for women with hypothyroidism during different periods of pregnancy.Methods Totally 120 women with hypothy—roidism during different periods from January 2013 to December 2014 were divided into group A and group B.The changes in TSH,standard situation of L-T4 saturated dose and pregnancy outcomes between the two groups were compared at 12 th,27th and 36 th weeks of pregnancy.Results There was no significant difference in TSH between the two groups at 12 th week of pregnancy（P 〉0.05）,and the levels of TSH at 27 th and 36 th of pregnancy in group A were lower than those of group B（P0.05）.All the patients reached the definitive therapeutic dosage at 12 th,27th and36 th week of pregnancy,and no significant difference was found in the number of patients whose dose was saturated between the two groups（P〈0.05）,while there were significant differences in saturated dose（P〉0.05）.Conclusion Pregnant hypothyroidism women should be treated individually,the therapy should be guided correctly and monitored timely,and the dose should be adjusted to achieve good clinical efficacy with low incidence of adverse pregnant outcome.