丙硫氧嘧啶、甲硫咪唑对妊娠期甲状腺功能亢进患者妊娠结局及糖脂代谢的影响比较

Comparison of effects of propylthiouracil and methimazole on pregnancy outcomes and glucose and lipid metabolism in patients with hyperthyroidism in pregnancy

目的比较丙硫氧嘧啶、甲硫咪唑治疗妊娠期甲状腺功能亢进(甲亢)对妊娠结局及糖脂代谢的影响,分析其应用安全性。方法将92例妊娠期甲亢患者随机分为观察组46例和对照组46例。两组患者均给予β-受体阻滞剂、保肝、提高白细胞等常规辅助治疗。观察组给予丙硫氧嘧啶治疗,对照组给予甲硫咪唑治疗。连续治疗3个月后,对两组患者的甲状腺素水平[促甲状腺激素(TSH)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]、妊娠结局、糖脂代谢水平[空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、三酰甘油(TG)]、肝功能指标[丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、天门冬氨酸氨基转移酶(AST)]及母体并发症发生情况进行比较。结果治疗后,观察组TSH明显高于对照组,T3、T4、FT3、FT4明显低于对照组,差异均有统计学意义(P<0.05);观察组在早产、流产、胎死宫内、胎儿窘迫、妊娠期高血压方面明显低于对照组,足月产方面明显高于对照组,差异均有统计学意义(P<0.05);治疗后观察组患者FPG、FINS、TC、TG明显低于对照组,差异均有统计学意义(P<0.05);治疗后观察组ALT、ALP、AST水平上升幅度明显低于对照组,差异均有统计学意义(P<0.05);观察组产褥感染、甲亢心脏病、糖尿病、羊水过少、胎盘早剥、妊娠期高血压等并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论丙硫氧嘧啶较甲硫咪唑更有利改善妊娠期甲亢患者的甲状腺功能、妊娠结局及糖脂代谢水平,且具有较高的安全性。

ObjectiveTo compare the effects of propylthiouracil and methimazole on pregnancy outcomes and glucose and lipid metabolism in patients with hyperthyroidism in pregnancy,and to analyze the security.MethodsTotally 92 patients with hyperthyroidism in pregnancy were divided into the observation group(46 cases)and control group(46 cases).Patients in both groups were given routine adjuvant therapy,such asβ-blocker,liver protection,increasing white blood cells.The patients in observation group were treated with propylthiouracil while the patients in control group were treated with methimazole.The thyroxine levels(TSH,T3,T4,FT3,FT4),pregnancy outcomes,glucose and lipid metabolism(FPG,FINS,TC,TG),liver function indicators(ALT,ALP,AST)and maternal complications of two groups were compared after treatment for 3 months.ResultsThe TSH level of the observation group was significantly higher than that of the control group,and the T3,T4,FT3,FT4 levels of the observation group were significantly lower than those of the control group(P<0.05).The incidence of premature birth,miscarriage,intrauterine fetal death,fetal distress and gestational hypertension of observation group were significantly lower than those of the control group,but the incidence of full-term production of observation group was significantly higher than that of the control group(P<0.05).The FPG,FINS,TC and TG levels of the observation group were significantly lower than those of the control group(P<0.05).The increased amplitude of ALT,ALP,AST of the observation group were significantly lower than those of the control group(P<0.05).There were puerperal infection,hyperthyroid heart disease,diabetes,oligohydramnios,placental abruption,pregnancy-induced hypertension and other complications occurred in both two groups,but the incidence of the observation group were significantly lower than those of the control group(P<0.05).ConclusionCompared with methimazole,propylthiouracil is more beneficial to improve thyroid function,pregnancy outcome and glucose and lipid metabolism in patients with hyperthyroidism in pregnancy,and has higher security.