妊娠合并甲减患者LT4治疗剂量与甲功变化相关性研究

Correlation between levothyroxine dose variation and thyroxine value in pregnancy women with hypothyroidism

目的探讨妊娠合并甲减患者孕前、孕期及产后甲状腺功能及使用左甲状腺素片(LT4)剂量变化及其相关性。方法选择32例临床甲减患者为A组及58例亚临床甲减患者为B组,定期检测血清中TSH、FT4、FT3水平并调整LT4剂量。结果在各个阶段A组患者服用LT4剂量均高于B组,差异有统计学意义(P<0.05)。随着孕周的增加,两组患者服用LT4的剂量均增加,孕前至孕22周变化较大,孕22~37周均保持稳定,产后下降。两组患者在各个阶段服用LT4的增加量、血清TSH、FT4和FT3值变化趋势差异无统计学意义(P>0.05)。结论妊娠合并甲减患者服用LT4的剂量在孕22周前变化较大,孕22周后保持稳定。孕期LT4剂量平均较孕前增加70%~90%。孕期规范治疗可减少妊娠不良结局的发生。

Objective To evaluate the correlation between levothyroxine（LT4） dose variation and thyroxine value in hypothyroidism women during pre-pregnancy,pregnancy and postpartum. Methods Selected 32 clinical hypothyroidism women as group A and 58 subclinical hypothyroidism women as group B. Preiodically monitored serum TSH, FT4 and FT3 levels and adjusted LT4 dose accordingly. Results The required LT4 of group A was significantly higher than group B in each phase（P〈0.05）. LT4 needed dose increased in both groups with the increase in gestational age. From pre-pregnancy to the 22 th week,the change of LT4 dose was larger, but during the 22 th week and 37 th week, the mean LT4 dose remained almost constant,after delivery it droped in both two groups. There were no significant differences of increment in the LT4 dose, the change tendency on serum TSH, FT4 and FT3 value between the two groups（P〉0.05）. Conclusion The LT4 dose has a larger variation of pregnancy with hypothyroidism before the 22 th week, and it remains stable after the 22 th week. The average increase of LT4 dose is about 70%~90% of the original dose, standard treatment can reduce adverse pregnancy outcomes.