硒酵母片联合左旋甲状腺素治疗妊娠期SCH的疗效观察

Effects of Selenious Yeast Tablets combined with levothyrocine in treatment of gestational SCH

目的研究硒酵母联合左旋甲状腺素对妊娠期抗甲状腺过氧化物酶抗体(TPOAb)阳性的亚临床甲状腺功能减退症(SCH)患者的疗效。方法将147例妊娠期SCH患者随机分为试验组(74例)和对照组(73例),对照组给予左旋甲状腺素片治疗,试验组给予硒酵母片联合左旋甲状腺素片治疗。治疗3个月后及妊娠结束时,比较两组甲状腺功能、TPOAb水平的变化以及妊娠结局和并发症发生率。结果两组治疗均能有效维持患者血清游离甲状腺素(FT4)水平,治疗期间,两组FT4均未出现明显的变化;治疗3个月及妊娠结束时,两组血清促甲状腺激素(TSH)及TPOAb水平均较治疗前显著下降(P <0.05),且试验组显著低于对照组(P <0.05)。试验组流产、早产、胎儿窘迫及不良妊娠结局总发生率均较对照组明显降低(P <0.05);两组妊娠期高血压、妊娠期糖尿病、孕妇中重度贫血、羊水异常的发生率比较无统计学差异(P> 0.05)。结论左旋甲状腺素联合硒酵母治疗妊娠期SCH患者,能有效降低患者TSH和TPOAb水平,减少不良妊娠结局的发生。

Objective To study the effects of selenious Yeast Tablets combined with levothyrocine in the treatment of gestational subclinical hypothyroidism(SCH) with positive anti-thyroid peroxidase antibody(TPOAb). Methods A total of 147 patients with gestational SCH were randomly divided into an experiment group(n=74) and a control group(n=73). The control group was treated with levothyrocine and the experiment group with Selenious Yeast Tablets combined with levothyrocine. After three months of treatment and at the end of the gestation, the changes in thyroid function and TPOAb levels, gestation outcomes and the incidence of complications were compared between the two groups. Results The treatment in the two groups could effectively maintain the levels of serum free thyroxin(FT4) in patients. During the treatment, the FT4 in the two groups showed no significant change; after three months of treatment and at the end of the gestation, the levels of the serum thyroid stimulating hormone(TSH) and TPOAb were significantly lower than those before the treatment(P < 0.05), and the levels in the experiment group were significantly lower than those in the control group(P < 0.05). The overall incidence of abortion, preterm birth, fetal distress and adverse gestation outcomes in the experiment group was significantly lower than that in the control group(P < 0.05); there was no statistical difference in the incidence of gestational hypertension, gestational diabetes, moderate to severe anemia and abnormal amniotic fluid between the two groups(P > 0.05). Conclusion Levothyrocine combined with Selenious Yeast Tablets can effectively lower TSH and TPOAb levels and reduce adverse gestation outcomes.