叶酸代谢水平及叶酸干预对妊娠期亚临床型甲状腺功能减退并轻度贫血患者的影响

Effect of folate metabolism and folic acid intervention on pregnancy in patients with subclinical hypothyroidism and mild anemia

目的探讨妊娠期亚临床型甲状腺功能减退并轻度贫血患者叶酸水平及叶酸干预对妊娠的影响。方法选取2018年1-11月在武汉市红十字会医院和上海市宝山区罗店医院产科门诊首次产检且孕12周的孕妇89例,根据血常规及甲状腺功能五项检测结果,分为观察组21例(无合并症孕妇)、研究I组35例(合并亚临床型甲状腺功能减退孕妇)、研究II组33例(合并亚临床型甲状腺功能减退并轻度贫血孕妇),所有研究对象进一步检测血清叶酸及铁蛋白水平,依据检测结果,研究Ⅰ和Ⅱ组均给予优甲乐治疗,另外,研究II组17例孕妇补充叶酸及铁剂、16例孕妇单纯补充铁剂。比较3组孕妇血清促甲状腺激素释放激素(TSH)、叶酸及铁蛋白水平的差异性,随访研究Ⅱ组纠正贫血治疗的效果。结果研究I组和研究II组孕妇血清叶酸和铁蛋白水平明显低于观察组,差异有统计学意义(P<0.05);研究Ⅱ组血清叶酸和铁蛋白水平低于研究I组,差异有统计学意义(P<0.05)。研究II组单纯铁剂补充者贫血及低甲状腺素血症纠正效果显著低于叶酸联合铁剂补充者(P<0.05)。结论妊娠期亚临床型甲状腺功能减退影响体内叶酸及铁离子代谢,容易诱发妊娠期贫血,精准补充叶酸和铁剂对纠正贫血及低甲状腺素血症效果更佳。

Objective To investigate the effects of folic acid levels and folic acid intervention on pregnancy in patients with subclinical hypothyroidism and mild anemia during pregnancy.Methods A total of 89 pregnant women of 12 weeks'gestation underwent their first antenatal check-up at the maternity clinic of Wuhan Red Cross Hospital and Shanghai Baoshan District Luodian Hospital from January to November 2018.According to the results of five tests of blood routine and thyroid function,21 patients in the observation group(pregnant women without comorbidities),35 patients in group I(combined with subclinical hypothyroidism),and 33 patients in groupⅡ(combined with subclinical type)Hypothyroidism and mild anemia in pregnant women.All subjects were further tested serum folate and ferritin levels,then,groupⅠandⅡwere treated with Euthyrox according to the results.In addition,17 patients in groupⅡwere supplemented with folic acid and iron,and 16 women were supplemented with iron alone.The differences of serum thyroid stimulating hormone,folic acid and ferritin levels in the three groups of pregnant women were compared.The effect of the treatment of anemia in groupⅡwas followed up.Results The levels of serumfolate and ferritin in study groupⅠand Study groupⅡwere significantly lower than those in the observation group(P<0.05).The levels ofserum folate and ferritin in Study groupⅡwere significantly lower than those in study groupI(P<0.05).The corrective effect of anemia and hypothyroxinemia in groupⅡsimple iron supplement was significantly lower than that in folic acid combined with iron supplement(P<0.05).Conclusion Subclinical hypothyroidism during pregnancy affects the metabolism of folic acid and iron ions in the body,which is easy to induce anemia during pregnancy.Accurate supplementation of folic acid and iron is better for correcting anemia and hypothyroxemia.