左旋甲状腺素在亚临床甲状腺功能减退症孕妇中治疗对血清叶酸和甲状腺功能的影响

Effect of levothyroxine on serum folic acid and thyroid function in the treatment of pregnant women with subclinical hypothyroidism

目的:研究左旋甲状腺素(L-T4)在亚临床甲状腺功能减退症(sub clinical hypothyroidism,SCH)孕妇中治疗对血清叶酸及甲状腺功能的影响。方法:选取我院收治的35例SCH孕妇为观察组,另选妊娠期甲状腺功能正常孕妇35例为对照组。观察组孕妇接受L-T4治疗。比较血清叶酸(folic acid,FA)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)等指标治疗前组间及治疗后观察组组内变化情况。结果:观察组孕妇治疗前血清FA水平显著低于对照组(P<0.01),TSH、TC、TG及LDL-C水平显著高于对照组(P<0.01),且TSH水平与FA呈负相关(r=-0.37,P<0.05),与TC及LDL-C水平呈正相关(r_(TC)=0.23,r_(LDL-C)=0.31,P<0.05);观察组孕妇治疗后相关指标水平与对照组差异无统计学意义(P>0.05)。结论:FA水平降低和高TC及LDL-C与孕妇发生SCH存在一定相关性,左旋甲状腺素能提高SCH孕妇血清FA水平,改善甲状腺功能,是治疗SCH的良好选择。

Objective：To observe the effect of levothyroxine on serum folic acid （FA） and thyroid function in the treatment of pregnant women with subclinical hypothyroidism （SCH）. Methods：35 cases of pregnant women with SCH treated with levothyroxine in the hospital were selected as ob- servatian group while 35 cases of pregnant women with normal thyroid function were selected as control group. The changes of levels of FA, thyroid stimulating hormone （TSH）, free triiodothyronine （FT3 ）, free thyroxine （FT4 ）, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL -C ） and high density lipoprotein cholesterol （HDL -C） before and after treatment in the two groups were compared. Results：Be- fore treatment, the level of FA in observation group was significantly lower than that in control group（ P 〈0.01 ）, the levels of TSH, TC, TG and LDL - C were significantly higher than those in control group （ P 〈0.01 ） and TSH level was negatively correlated with FA（ r = -0.37, P 〈0.05） and positively correlated with TC and LDL - C （ r TC = 0.23, r LDL- C = 0.31, P 〈 0.05 ）. After treatment, the level of serum FA in observation group improved significantly （ P 〈 0.01 ） and the levels of TSH, TC, TG and LDL - C reduced significantly （ P 〈 0.01 ）. Conclusion： The low level of FA and high level of TC and LDL - C have certain correlations with SCH in pregnant women. Levothyroxine can enhance the level of serum FA in pregnant women and improve their thyroid function, which is a good choice in treating pregnant women with SCH.