左甲状腺素钠治疗妊娠期亚临床甲状腺功能减退症的临床研究

Clinical study of levothyroxine sodium in the treatment of subclinical hypothyroidism during pregnancy

目的探讨左甲状腺素钠对妊娠期亚临床甲状腺功能减退症(SCH)患者同型半胱氨酸(Hcy)、抗甲状腺过氧化酶抗体(TPO-Ab)、甲状腺功能、叶酸和维生素B12水平及妊娠结局影响。方法选择绍兴市中心医院2018年1月至2019年8月诊治的妊娠期SCH患者120例,依据随机数字表法分为对照组、观察组各60例;观察组给予左甲状腺钠治疗,对照组给予甲状腺素片治疗。比较两组治疗前后Hcy和TPO-Ab、甲状腺功能和叶酸水平变化及妊娠结局。结果观察组治疗后血清Hcy[(7.79±0.64)μmol/L]和TOP-Ab[(26.59±2.76)U/L],均低于对照组[(8.49±0.87)μmol/L和(30.49±3.25)U/L](t=5.020、7.085,均P<0.05);观察组治疗后血清TSH为(2.25±0.48)mIU/L,低于对照组的(3.49±0.70)mIU/L(t=11.317,P<0.05);观察组治疗后叶酸[(12.17±1.08)μg/L]和维生素B12[(487.23±26.23)ng/L],均低于对照组[(10.80±1.29)μg/L和(442.81±31.56)ng/L](t=6.308、8.385,均P<0.05);观察组不良妊娠结局发生率(10.00%)低于对照组(28.33%)(χ2=6.508,P<0.05)。结论左甲状腺素钠可降低SCH患者Hcy和TPO-Ab水平,提高TSH、叶酸和维生素B12水平,且可降低不良妊娠结局发生率。

Objective To investigate the effect of levothyroxine sodium tablets on homocysteine(Hcy),antithyroid peroxidase antibody(TPO-Ab),thyroid function,folic acid and vitamin B12 levels and pregnancy outcome in patients with subclinical hypothyroidism(SCH)during pregnancy.Methods From January 2018 to August 2019,120 cases of pregnant SCH patients in Shaoxing Central Hospital were selected and divided into control group and observation group according to the random digital table method,with 60 cases in each group.The observation group was given levothyroxine sodium tablet intervention,while the control group was not given any drug intervention.The changes of Hcy,TPO-Ab,thyroid function,folate level and pregnancy outcome were compared before and after treatment.Results The serum levels of Hcy[(7.79±0.64)μmol/L]and TPO-Ab[(26.59±2.76)U/L]in the observation group were lower than those in the control group[(8.49±0.87)μmol/L and(30.49±3.25)U/L](t=5.020,7.085,all P<0.05).The serum TSH level[(2.25±0.48)mIU/L]in the observation group was lower than that in the control group[(3.49±0.70)mIU/L](t=11.317,P<0.05).The levels of folate[(12.17±1.08)μg/L]and vitamin B12[(487.23±26.23)ng/L]in the observation group were lower than those in the control group[(10.80±1.29)μg/L and(442.81±31.56)ng/L](t=6.308,8.385,all P<0.05).The incidence of adverse pregnancy outcome in the observation group(10.00%)was lower than that in the control group(28.33%)(χ2=6.508,P<0.05).Conclusion Levothyroxine sodium tablets can reduce Hcy and TPO-Ab levels,increase TSH,folate and vitamin B12 levels,and reduce adverse pregnancy outcomes.