L-TH4对妊娠亚临床甲减糖代谢影响与过氧化物酶的关系研究

Effects of L-TH4 in pregnancy subclinical hypothyroidism on TPO and glycometabolism

目的 探讨左旋甲状腺素（Levo-thyroid hormone,L-TH4）对妊娠期亚临床甲状腺功能减退症（Subclinical hypothyroidism,SCHT）患者预后影响,并研究L-TH4与甲状腺过氧化物酶（Thyroid peroxidase,TPO）和糖代谢之间的关系,为临床防治SCHT提供理论依据。方法 选取孕妇60例,均分为3组,每组20例。空白对照组：随机选取甲状腺功能筛查正常的孕妇;SCHT组：选取只在产前筛查出的未经治疗的SCHT患者,作为疾病对照组;L-TH4治疗组：在妊娠6-12 w行常规甲状腺功能筛查,SCHT患者给予L-TH4规范化治疗。实验中在孕早期及产前分别取血,观察孕早期及产前血糖及糖化血红蛋白的改变;测定TSH和TPO活性,并取胎盘组织观察SCHT患者的胎盘病理改变,评价L-TH4对SCHT妊娠结局的影响。结果 与空白对照组相比,SCHT疾病组血糖及HbA1c均升高,L-TH4能降低SCHT患者的血糖及HbA1c水平,并降低TSH水平和TPO活性,与SCHT组比较,差异有统计学意义（P〈0.05）。L-TH4能改善SCHT患者胎盘组织病理改变。结论 L-TH4能降低SCHT患者的血糖及HbA1c水平,以及降低SCHT患者TSH水平和TPO活性,并能改善SCHT患者胎盘组织病理改变。

Objective To investigate the effects of levothyroxine （Levo-thyroid hormone,L-TH4） in pregnancy subclinical hypothyroidism （SCHT）, and study the relationship between L-TH4 with thyroid peroxidase （TPO） and glucose metabolism. The research could provide theoretical basis for the treatment of SCHT. Methods Sixty pregnant women were selected and signed the medical informed consent. The pregnancy were divided into three groups, 20 cases in each group.Normal control group： pregnancy underwent routine thyroid function normal; SCHT group： SCHT pregnancy patients who did not use drugs to treat SCHT; L-TH4 group： SCHT pregnancy patients given L-TH4 treatment. The blood was taken to test the contents of glucose level and HbA1c were observed; the activity of TSH and TPO were tested by ELISA method; HE staining method was used to observe the changing of placenta tissue. Results Compared with normal control group, the glucose and HbA1c were significantly increased in SCHT group （P〈0.05）. However, L-TH4 could decrease these index, compare with the SCHT group, and reduce the level of TSH and the activity of TPO, the difference was statistically significantly （P〈0.05）. Moreover, L-TH4 could improve the changing of placenta tissue. Conclusion L-TH4 could reduce blood glucose and HbA1c levels, also reduced the level of TSH and the activity of TPO in SCHT. L-TH4 could improve the changing of placenta tissue.