甲状腺激素干预治疗对妊娠期甲状腺功能减退患者妊娠结局的影响

Effects of intervention of thyroid hormones on pregnancy outcomes of women with hypothyroidism during pregnancy

目的探讨甲状腺激素干预治疗对妊娠期甲状腺功能减退患者妊娠结局的影响。方法选取2016年4月至2018年4月阳煤集团总医院收治的妊娠合并甲状腺功能减退患者286例为研究对象,采用掷骰子的方式,将抽取到偶数的患者纳入研究组,将抽取到奇数的患者纳入对照组,每组143例。对照组给予常规补碘治疗,观察组在此基础上给予甲状腺激素治疗,比较两组治疗效果,并分析对患者妊娠结局、新生儿情况、妊娠并发症发生率及甲状腺激素水平的影响。结果研究组早产、流产、剖宫产、胎膜早破、胎盘早剥发生率均低于对照组,差异有统计学意义(P<0.05);治疗后两组促甲状腺激素(TSH)降低,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均升高,且研究组治疗后TSH低于对照组,FT3、FT4高于对照组,差异有统计学意义(P<0.05);研究组胎儿窘迫、低体质量儿发生率及新生儿Apgar评分均低于对照组,差异有统计学意义(P<0.05);研究组妊娠期高血压、妊娠期糖尿病、羊水过少、胎位异常发生率均低于对照组,差异有统计学意义(P<0.05)。结论甲状腺激素在妊娠期合并甲状腺功能减退孕妇中应用较佳,可显著改善孕妇的甲状腺功能及新生儿情况,并降低不良妊娠结局及妊娠并发症发生率,疗效确切。

Objective To investigate the effects of intervention of thyroid hormones on pregnancy outcomes in women with hypothyroidism during pregnancy. Methods A total of 286 patients with hypothyroidism during pregnancy who were hospitalized by Yangmei Group General Hospital from April 2016 to April 2018 were selected as research subjects. By throwing dice, patients threw even numbers were included in study group (n=143) while patients threw odd numbers were included in control group (n=143). Patients in control group were given conventional iodine supplementation. Patients in observation group were given thyroid hormone therapy based on the treatment of control group. The treatment effects were compared between the two groups, and the effects on pregnancy outcomes, neonatal condition, incidence of pregnancy complications and levels of thyroid hormones were analyzed. Results The incidences of premature delivery, abortion, cesarean section, premature rupture of membranes and placental abruption in study group were significantly lower than those in control group (P<0.05). Thyroid stimulating hormone (TSH) levels in both groups were significantly decreased, while levels of free triiodothyronine (FT3) and free thyroxine (FT4) were increased after treatment (P<0.05). TSH levels in study group were lower than those in control group, while levels of FT3 and FT4 were higher than those in control group after treatment (P<0.05). The incidence of fetal distress and low body weight, and neonatal Apgar score in study group were significantly lower than those in control group (P<0.05). The incidences of complications such as gestational hypertension, gestational diabetes, oligohydramnios and abnormal fetal position in study group were significantly lower than those in control group (P<0.05). Conclusions The effects of thyroid hormones are relatively better in pregnant women with hypothyroidism during pregnancy. Thyroid hormones intervention can significantly improve the thyroid function and neonatal condition, and reduce the incidence of adverse pregnancy outcomes and complications.