左旋甲状腺素片干预后对甲状腺功能正常TPOAb阳性孕妇妊娠结局的影响

On effect of the Intervention of Levothyroxine Tablets on the Pregnancy Outcome of Pregnant Women with Normal Thyroid and Positive TPOAb

目的:旨在分析探讨对甲状腺功能正常但是TPOAb阳性的孕妇采取左旋甲状腺素片干预后对其妊娠结局的影响。方法:选取某院妇产科自2016年3月1日~2016年12月31日的孕妇,按照先前建立的本地区妊娠期特异的甲状腺功能参考值范围及甲状腺自身抗体水平,从入选孕妇中筛查出甲状腺功能正常但TPOAb阳性的孕妇,共800例。将这800例的甲状腺功能正常而TPOAb阳性的孕妇采取随机计数法平均分为两组,其中观察组400例孕妇,对照组400例孕妇。对观察组的孕妇给予每日50ug左旋甲状腺素片(L-T4)的干预治疗,对照组的孕妇予相同剂量的安慰剂,分别对L-T4干预后甲状腺功能正常TPOAb阳性孕妇与口服安慰剂的甲状腺功能正常TPOAb阳性孕妇进行随访直至妊娠结束,分别比较孕妇不良妊娠结局的发生率,其中不良妊娠结局观察的指标为早产、胎儿生长受限、新生儿肺炎等,同时分析产生不良妊娠的危险因素。结果:两组孕妇的妊娠结局显示,对照组孕妇的胎儿早产发生率为6.3%,观察组孕妇的胎儿早产率为1.3%,未进行左旋甲状腺素片干预的对照组显著高于观察组(P<0.05);观察组孕妇的胎儿生长受限发生率为1.8%,对照组孕妇的胎儿生长受限发生率为5.2%,未进行左旋甲状腺素片干预的对照组显著高于观察组(P<0.05);观察组孕妇的新生儿肺炎发生率为1.0%,对照组孕妇的新生儿肺炎发生率为6.0%,未进行左旋甲状腺素片干预的对照组显著高于观察组(P<0.05);观察组孕妇不良妊娠结局发生率明显低于对照组孕妇,且二者具有显著差异(P<0.05)。结论:在甲状腺功能正常时,TPOAb阳性对孕妇的妊娠结局可产生多种不良影响,采取左旋甲状腺素进行干预治疗,可有效降低不良妊娠结局的发生率。

Objective：This paper is to analyze the intervention of levothyroxine tablets on the pregnancy outcomes of pregnant women with normal thyroid and positive TPOAb.Methods：Select pregnant women received in obstetrics and gynecology department of some hospital during the period from March 1st,2016 to December 31,2016,according to previously established specific reference range of thyroid function and level of thyroid autoantibodies during gestation period in our region,among the selected pregnant women,800 cases with normal thyroid but positive TPOAb were screened out.the 800 cases of pregnant women with normal thyroid but positive TPOAb was averagely divided into two groups according to random counting method,400 cases for observation group and 400 ones for control group.In the observation group,the pregnant womenn were daily treated with 50 ug of levothyroxine tablets（L-T4）,while the women in control group were treated with same dose of placebo.Pay follow-up to the pregnant women with normal thyroid and positive TPOAb after the the intervention of levothyroxine tablets and those who orally taken placebo until the termination the pregnancy,to compare the occurance rate of adverse pregnancy outcome,and the indicators according to obsevation on adverse pregnancy outcome including preterm,fetal growth restriction,neonatal pneumonia and so on,at the same time,risk factors resulted in these adverse pregnancy outcomes were analyzed.Results：The pregnancy outcomes of two groups of pregnant women showed that the incidence of premature birth was 6.3%in control group,while the rate of the pregnant women in observation group was 1.3%,the rate of the control which did not intervened with levothyroxine tablets was significantly higher than that in observation group（P〈0.05）;the occurance rate of fetal growth restriction in observation group was 1.8%,while the rate was 5.2%in control group,the rate of the control which did not intervened with levothyroxine tablets was significantly higher than that in observation group（P 0.05）;the occurance rate of neonatal pneumonia in observation group was 1.0%,while the rate in control group was 6.0%,the rate of the control which did not intervened with levothyroxine tablets was significantly higher than that in observation group（P〈0.05）;The incidence of adverse pregnancy outcomes in the observed group was significantly lower than that in the control group,and the differences were significant（P〈0.05）.Conclusion：If thyroid functions well,there would be varous avesrse effect of positivity of TPOAb on the outcome the pregnant women,to treat with levothyroxine tablets can effectively reduce the incidence of adverse pregnancy outcomes.