小剂量左甲状腺素干预治疗早期妊娠合并亚临床甲状腺功能减退症的临床疗效分析

The clinical effective of small doses of sinistral thyroxine in the early treatment of pregnancy with subclinical hypothyroidism

目的：探讨使用小剂量左甲状腺素早期治疗妊娠合并亚临床甲状腺功能减退症（subclinical hypothyroidism，SCH）的临床疗效及内脏脂肪的变化。方法研究分析2014年3～12月在上海交通大学医学院附属同仁医院早孕门诊的57例育龄妇女，其中39例为SCH孕妇，使用小剂量左甲状腺素钠进行早期治疗，对照组为同期检查的18例非甲减患者。用药2周后、6周后分析两组患者相关指标变化，随访至产后4周，并进行综合分析。结果两组患者入组前总三碘甲状腺原氨酸（total triiodothyronine 3， TT3）、基础代谢率、体脂含量、内脏脂肪等级差异均无显著性；治疗前总甲状腺素（total thyroxine，TT4）、游离甲状腺激素（free thyroxine index，FT4）、促甲状腺激素（thyroid stimulating hormone，TSH）水平差异有显著性（P均＜0.05）。患者在经过2周、6周治疗后，TT4与FT4指标与对照组相比，差异无显著性（P＞0.05）；而TSH虽仍然有差异，但是与治疗前两者的统计学差异相比，得到了显著下降（P＜0.05）。结论小剂量左甲状腺素治疗早期妊娠合并SCH具有一定的临床疗效，可进行进一步的研究。左甲状腺素可能对早期妊娠合并SCH妇女的体脂含量及内脏脂肪的合成有抑制作用。

ObjectiveThis study investigated the effectiveness of small doses of sinistral thyroxine in the early treatment of pregnancy with subclinical hypothyroidism.Method The data of 57 pregnancy women of childbearing age in March 2014 to December 2014 in Tongren hospital of Shanghai Jiaotong university were analyzed. The treatment group were SCH pregnant women （39 cases）, using small dose of levothyroxine sodium for early treatment. The cases of control group were without treatment. After two weeks, all the data was analyzed.Result Before the treatment, the total triiodothyronine 3（TT3）, basal metabolic rate, body fat and visceral fat level had no statistical difference. But the total thyroxine （TT4）, free thyroxine index （FT4）, TSH had a statistically difference （P〈0.05）. After 2 weeks, the TT4 and FT4 in the patients of treatment group were no statistical difference compared with the control group, （P〉0.05）. And the TSH, had been decreased significantly in the statistical difference compared with before（P〈0.05）.Conclusion These findings suggest that using small doses of sinistral thyroxine in early treatment of pregnancy with subclinical hypothyroidism has a certain clinical curative effect. It has the value of further research.