早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床研究

Clinical study of early comprehensive intervention combined with levothyroxine sodium in the treatment of hypothyroidism in pregnancy

目的探讨早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床效果及其对生化指标的影响。方法将2012年1月至2016年12月遵化市人民医院收治的194例妊娠合并甲状腺功能减退症病人按随机数字表法分为研究组(97例)和对照组(97例),对照组病人给予早期综合干预治疗,研究组病人给予早期综合干预联合左甲状腺素钠治疗。观察两组病人治疗后分娩结局(妊娠终止、自然分娩、阴道助产、剖宫产)、母婴结局(产后出血、宫缩乏力、胎儿窘迫及新生儿窒息)以及预后效果,同时检测治疗前后相关生化指标[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺刺激激素(TSH)、人绒毛膜促性腺激素(hC G)和脂联素(ADPN)]和社会支持评定量表(SSRS)评分变化。结果联合治疗后研究组病人妊娠终止率(5. 15%比22. 68%)、剖宫产率(6. 19%比26. 80%)、产后出血率(10. 31%比35. 05%)、宫缩乏力率(9. 28%比36. 08%)、胎儿窘迫率(11. 34%比34. 02%)及新生儿窒息率(10. 31%比31. 96%)低于治疗后的对照组(χ2值依次=12. 43、14. 97、16. 93、19. 87、14. 23、13. 64,均P <0. 001),自然分娩率68 (70. 10%)、总有效率93 (95. 88%)高于治疗后的对照组[30(30. 93%)、71(73. 20%)](均P <0. 05),而治疗后两组病人阴道助产率比较差异无统计学意义(P> 0. 05);治疗后两组病人生化指标(FT3、FT4、hC G和ADPN)和SSRS评分高于治疗前,而TSH低于治疗前(P <0. 05);与治疗后对照组相比,治疗后研究组病人生化指标(FT3、FT4、hC G和ADPN)和SSRS评分升高,而TSH降低(P <0. 05)。结论早期综合干预联合左甲状腺素钠可有效改善妊娠合并甲状腺功能减退症病人分娩结局、母婴结局、生化指标以及预后。

Objective To observe the clinical effection of early comprehensive intervention combined with levothyroxine sodium in thetreatment of hypothyroidism of pregnancy and the generated effects on biochemical indexes. Methods A sample of 194 pregnant women affected with hypothyroidism in the People’s Hospital of Zunhua were selected and randomly divided in to two groups: the research group and the control group. The control group were treated with early comprehensive intervention while the research group were treated with early comprehensive intervention combined with levothyroxine sodium. The delivery results(Termination of pregnancy,spontaneous delivery,vaginal delivery,cesarean section),mother-infant outcomes(Postpartum hemorrhage,atony of uterus,fetal distress and asphyxia of the newborn),and prognosis were observed,and the biochemical indexes [free triiodinated thyroiine 3(FT3),free triiodinated thyroiine 4(FT4),thyrotropin stimulating hormone(TSH),human chorionic gonadotropin(hC G) and adiponectin(ADPN) ] and Social Support Rating Scale(SSRS) score were examined to compare the difference between the two therapies. Results After treatment,termination rate of pregnancy(5. 15% vs. 22. 68%),cesarean section rate(6. 19% vs. 26. 80%),postpartum hemorrhage(10. 31% vs. 35. 05%),atony of uterus(9. 28% vs. 36. 08%),and fetal distress(11. 34% vs. 34. 02%) and asphyxia of the newborn(10. 31% vs. 31. 96%) in the research group was significantly lower than that in the control group(χ2= 12. 43,14. 97,16. 93,19. 87,14. 23,13. 64,P < 0. 001),the rate of natural childbirth,total efficiency,and excellent rate in the research group was significantly higher than that in the control group(P < 0. 05). However,there was no significant difference in vaginal delivery between the two groups(P > 0. 05). Compared with before treatment,biochemical indexes [Free triiodothyronine 3(FT3),Free thyroxine(FT4),Human chorionic gonadotropin(hC G),and Adiponectin(ADPN) ] and SSRS score in two groups after treatment significant increased but thyroid stimulating hormone(TSH) significant decreased(P < 0. 05). Compared with the control group after treatment,biochemical indexes(FT3,FT4,hC G,and ADPN) and SSRS score in the research groups after treatment significant increased but TSH significant decreased(P < 0. 05). Conclusion Early comprehensive intervention combined with levothyroxine effectively improves outcomes of labor,outcomes of mother and baby,biochemical indexes,and prognosis in pregnancy with hypothyroidism.