不同治疗方案对TPOAb阴性亚临床甲状腺功能减退孕妇妊娠结局的影响

Effect of different treatment schemes on the pregnancy outcome of pregnant women with TPOAb negative subclinical hypothyroidism

目的:研究优甲乐、硒酵母片、联合优甲乐与硒酵母片对甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阴性亚临床甲状腺功能减退孕妇妊娠结局的影响。方法:收集自2018年1—12月TPOAb阴性的亚临床甲状腺功能减退的孕8~12周孕妇408例,结合患者意愿分为对照组、优甲乐组、硒酵母片组和联合干预组,比较4组孕妇一般情况、不良妊娠结局、新生儿出生时不良状况、甲状腺功能变化。结果:各干预组的不良妊娠结局总数差异均有统计学意义(均P<0.05);各组间单独比较流产、妊娠期高血压、妊娠期糖尿病等不良妊娠结局时差异无统计学意义(P>0.05);各干预组与对照组出生不良状况发生总数及新生儿低体质量、巨大儿、早产等发生情况比较差异均无统计学意义(均P>0.05);优甲乐组及联合干预组可显著下调促甲状腺激素水平,同时上调游离三碘甲腺原氨酸(free triiodothyronine,FT)3、FT4的水平(P<0.05)。结论:优甲乐、硒酵母片、联合优甲乐与硒酵母片均可改善TPOAb阴性的亚临床甲状腺功能减退孕妇的不良妊娠结局,降低新生儿不良出生状况发生率。

Objective:To study the effect of levothyroxine sodium,selenium yeast,combined with levothyroxine sodium and selenium yeast on pregnancy outcome in pregnant women with subclinical hypothyroidism and thyroid peroxidase antibody(TPOAb)-negative.Methods:A total of 408 pregnant women during 8-12 weeks who received TPOAb-negative subclinical hypothyroidism from January to December 2018.Combined with the view of patients,they were divided into control group,levothyroxine sodium group,selenium yeast group,evothyroxine sodium and selenium yeast group.We compared the general conditions,the adverse pregnancy outcomes,the adverse conditions at birth and thyroid function in the four groups of pregnant women.Results:There were significant differences in the total number of adverse pregnancy outcomes among the intervention groups(P<0.05).There was no significant difference among the groups in the comparison of abortion,gestational hypertension,gestational diabetes and other adverse pregnancy outcomes(P>0.05).There was no significant difference in the birth defects between the intervention group and the control group(P>0.05).There was no significant difference in the number of birth defects between the intervention groups and the control group(P>0.05).In levothyroxine sodium and levothyroxine sodium combined with selenium yeast,thyroid stimulating hormone levels can be significantly reduced,while raising free triiodothyronine(FT)3,FT4 levels,and the difference is statistically significant(P<0.05).Conclusion:All of those,levothyroxine sodium,selenium yeast,combined with levothyroxine sodium and selenium yeast,could improve the adverse pregnancy outcome of pregnant women with subclinical hypothyroidism and TPOAb-negative.At the same time,intervention groups reduced the incidence of adverse birth conditions in neonates.