左甲状腺素钠片治疗妊娠合并甲状腺功能减退疗效分析

Analysis of curative effect by levothyroxine sodium tablets in the treatment of pregnancy complicated with hypothyroidism

目的观察左甲状腺素钠片用于治疗甲状腺功能减退症(甲减)、亚临床甲状腺功能减退症(亚临床甲减)的临床疗效,探讨甲减对妊娠及其结局的影响。方法 130例甲减及亚临床甲减孕妇,随机分为治疗组70例与观察组60例。治疗组采用左甲状腺素钠片治疗,观察组未给予治疗。分别在妊娠早期、妊娠中期、妊娠晚期及产后1周定期监测观察组促甲状腺激素(TSH)水平及甲状腺素需求量,比较两组并发症发生情况及妊娠结局。结果观察组妊娠中期、妊娠晚期、产后1周TSH水平为(1.93±0.78)、(1.34±0.56)、(0.58±0.31)m U/L,均低于妊娠早期的(2.45±0.55)m U/L(P<0.05)。观察组妊娠中期、妊娠晚期甲状腺素需求量为(122±18)、(147±16)μg,高于妊娠早期的(102±21)μg(P<0.05);产后1周甲状腺素需求量为(119±17)μg,低于妊娠晚期(P<0.05)。治疗组妊娠肝内胆汁淤积症发生率为1.43%、糖代谢异常发生率为2.86%、胎儿宫内窘迫发生率为1.43%、妊娠高血压综合征发生率为4.29%,均低于观察组的13.33%、16.67%、10.00%、16.67%(P<0.05)。治疗组早产发生率为2.86%、胎儿畸形发生率为0、新生儿窒息发生率为0、死胎发生率为0,均低于观察组的13.33%、8.33%、11.67%、8.33%(P<0.05)。结论对妊娠合并甲减的孕妇应定期监测血清TSH水平,妊娠期间随着孕周甲状腺激素的需要量增加,应及时调整用药剂量,甲减的治疗可以减少不良妊娠结局的发生,对孕期甲减筛查及监测和治疗意义重大。

Objective To observe clinical effects by levothyroxine sodium tablets in the treatment of hypothyroidism and subclinical hypothyroidism, and to investigate influence by hypothyroidism on pregnancy and outcome. Methods A total of 130 pregnant women with hypothyroidism and subclinical hypothyroidism were randomly divided into treatment group with 70 cases and observation group with 60 cases. The treatment group received levothyroxine sodium tablets for treatment and the observation group received no treatment. Detection of thyroid stimulating hormone（TSH） levels and demanded thyroxine quantity was taken in the first, second and third trimesters of pregnancy, and in postpartum 1 week. Complications and pregnancy outcomes of the two groups were compared. Results The observation group had lower TSH levels in the second and third trimesters of pregnancy, and in postpartum 1 week as（1.93±0.78）,（1.34±0.56） and（0.58±0.31）m U/L than（2.45±0.55）m U/L in the first trimester of pregnancy（P〈0.05）, and it had obviously higher demanded thyroxine quantity in the second and third trimesters of pregnancy as（122±18） and（147±16）μg than（102±21）μg in the first trimester（P〈0.05）, while its demanded thyroxine quantity in postpartum 1 week was lower as（119±17）μg than that in the third trimester of pregnancy（P〈0.05）. The treatment group had incidence of intrahepatic cholestasis of pregnancy as 1.43%, incidence of abnormal glucose metabolism as 2.86%, incidence of fetal distress in uterus as 1.43%, and incidence of pregnancy-induced hypertension as 4.29%, which were all lower than 13.33%, 16.67%, 10.00% and 16.67% of the observation group（P〈0.05）. The treatment group had incidence of premature delivery as 2.86%, incidence of fetal malformation as 0, incidence of neonatal asphyxia as 0, and incidence of stillbirth as 0, which were all lower than 13.33%, 8.33%, 11.67% and 8.33% of the observation group（P〈0.05）. Conclusion Regular monitoring of serum TSH level is necessary for pregnant women complicated with hypothyroidism, and timely medication adjustment ought to make in accordance with demanded thyroxine quantity during pregnancy. Treatment of hypothyroidism can reduce adverse pregnancy outcomes, and it contains important significance for screening, monitoring and treating hypothyroidism during pregnancy.