凉山彝族妇女妊娠期亚临床甲减对妊娠结局的影响

Influence of subclinical hypothyroidism on pregnancy outcome of women of YI nationality in Liangshan Autonomous Prefecture

目的:探讨凉山彝族妇女妊娠期亚临床甲状腺机能减退(SCH)对妊娠结局的影响。方法:2014年6月~2015年6月间部分凉山彝族妊娠期妇女因发生自然流产或新生儿Apgar评分低或新生儿低体重或进行住院分娩而发现TSH轻度异常,2015年9月~2017年6月对再次妊娠时仍处于SCH的496名妇女给予补充甲状腺激素,并按照TSH水平分为轻度、中度和重度SCH组(TSH分别为2.5~4.0μIU/ml、4.0~6.0μIU/ml和6.0~10.0μIU/ml)。3组治疗中TSH维持在相同范围,比较不同亚组干预前后自然流产发生率、新生儿Apgar评分及低体重儿发生率。结果:干预前3个SCH组间妊娠不良结局比较具有统计学意义,TSH越高,妊娠不良结局的发生率显著升高(P<0.01);轻度SCH组干预前后妊娠结局比较无显著性差异;中、重度SCH组干预前后妊娠不良结局有显著性差异(均P<0.05)。结论:亚临床甲减与妊娠不良结局相关,随TSH升高影响越显著。中、重度SCH补充甲状腺激素后能明显改善不良妊娠结局。

To study the influence of subclinical hypothyroidism （SCH）on pregnancy outcome of women of YI nationality during pregnancy.Methods ：Some YI pregnant women in Liangshan Autonomous Pre- fecture were found with abnormal thyroid function when they were in hospital for spontaneous abortion,low neonatal Apgar score,low birth weight newborns or giving birth from June 2014 to June 2015.A total of 496 subjects were still diagnosed as subclinical hypothyroidism during the next pregnancies from Sep.2015 to June 2017,and levo-thyroxine were prescribed for them in our hospital.Meanwhile they took some LT4 to maintain the TSH in the corresponding range.The pregnancy outcomes were compared before and after treatment.Re- suits：The incidence of adverse pregnancy outcomes between three SCH groups before intervention had statisti- cally significant difference （P〈0.01）.The higher TSH level,the higher incidence of the adverse pregnancy out- comes.The adverse pregnancy outcomes of mild SCH group showed no significant difference before and after intervention,but they showed significant difference in moderate and serious SCH groups after thyroxine（both P〈0.05）.Condusion：SCH is associated with the adverse pregnancy outcomes.The adverse outcomes became obvious as the TSH level rises.The pregnancy outcomes in the moderate and serious SCH groups improved markedly after thyroxine intervention.