孕妇妊娠早期甲减、亚甲减筛查及与不良妊娠结局的相关性和左甲状腺素干预效果

The correlation of adverse pregnancy outcomes and the intervention effects of levothyroxine in early pregnancy in diagnosis of hypothyroidism and subclinical hypothyroidism

目的 探讨孕妇妊娠早期甲减、亚甲减筛查的意义,评价妊娠早期甲减、亚甲减与不良妊娠结局的相关性及左甲状腺素干预的效果。方法 选取2015年4月～2016年4月永康市妇幼保健院产科门诊做产检的孕妇500例,常规产检的同时做甲功5项筛查。对检测结果统计分析,对甲减、亚甲减的孕妇进行随访,追踪其采用左甲状腺素干预的治疗效果及不良妊娠结局,探讨甲减、亚甲减与不良妊娠结局的相关性。结果 500例孕妇中,检出甲亢患病率1.2%（6/500）,甲减、亚甲减发病率11%（55/500）,其中甲减患病率0.8%（4/500）,亚甲减患病率10.2%（51/500）。甲减组TSH、T3、T4、FT3及FT4与甲功正常组比较差异有统计学意义（P〈0.05）,亚甲减组TSH、T3、T4及TT4与甲功正常组相比差异有统计学意义（P〈0.05）。55例甲减及亚甲减孕妇中25人接受左甲状腺素干预治疗,接受治疗组不良妊娠结局发生率显著低于未接受治疗组（P〈0.05）。结论 孕妇妊娠早期（1～20w）进行甲减、亚甲减筛查和及时运用左甲状腺素干预治疗能改善预后,降低不良妊娠结局的影响。

Objective To discuss the significance of the diagnosis of hypothyroidism or subclinical hypothyroidism and evaluate the correlation of adverse pregnancy outcomes and the intervention effects of levothyroxine in early pregnancy .Methods 500 pregnant women who from April 2015 to April 2016 came to our hospital obstetrics do prenatal outpatient service were served as the objects in our study, at the same time, all the pregnant women received the five items of thyroid function screening.The statistically analyzed the results and followed up the pregnant women who with hypothyroidism and subclinical hypothyroidism to learn the treatment and adverse pregnancy outcomes, so as to evaluate the correlation and the intervention effects. Results In 500 cases of pregnant women,there were 6 cases of hyperthyroidism （1.2%）,55 cases of hypothyroidism or subclinical hypothyroidism （11%）,includeing four cases of hypothyroidism and 51 cases of subclinical hypothyroidism.The values of TSH,T3, T4,FT3 and FT4 in the group of hypothyroidism pregnant women were significant different to the normal control group （P〈0.05）, the values of TSH, T3, T4 and FT4 in the group of subclinical hypothyroidism pregnant women were significant different to the normal control group （P〈0.05）.Then the 25 cases of pregnant women with hypothyroidism or subclinical hypothyroidism received the treatment with levothyroxine, and the incidence rate of adverse pregnancy outcomes in treatment group was significantly lower than the untreated group （ P〈0.05 ） .Conclusion The diagnosis of hypothyroidism or subclinical in early pregnancy and then treated with levothyroxine has important significant in decreasing the adverse pregnancy outcomes .