碘营养结合甲状腺激素替代疗法治疗妊娠期亚临床甲减效果及其妊娠结局

Effect of iodine nutrition combined with thyroid hormone replacement therapy for pregnant women with subclinical hypothyroidism and its pregnancy outcomes

目的:分析碘营养结合甲状腺激素替代疗法治疗妊娠期亚临床甲减效果。方法:选取2018年1月-2020年3月本院收治的妊娠期亚临床甲减患者150例,按数字随机表法分为对照组75例采用碘营养,观察组75例采用碘营养结合甲状腺激素替代疗法,对比两组甲状腺功能指标变化以及妊娠结局。结果:孕32周观察组血清游离甲状腺素(9.80±2.63 pmol/L)高于对照组(8.10±2.49 pmol/L),促甲状腺激素(1.50±0.51 mIU/L)低于对照组(2.01±0.49 mIU/L),24h收缩压(11.05±1.24 mmHg)、24h舒张压(6.24±1.15 mmHg)变异系数低于对照组(13.46±1.36 mmHg、7.36±1.20 mmHg),妊娠不良结局发生率(4.0%)低于对照组(13.3%)(均P<0.05)。围生儿不良结局发生率观察组(1.3%)与对照组(4.0%)无差异(P>0.05)。治疗期间两组患者均能耐受,观察组1例(1.3%)发生心悸不适,经降低替代剂量后症状恢复,后逐渐增加靶剂量无不适感;对照组未出现心悸不适感顺利完成治疗。结论:碘营养结合甲状腺激素替代疗法可显著改善妊娠期亚临床甲减患者甲状腺功能,减少妊娠不良结局的发生,安全性较好。

Objective:To analyze the effect of iodine nutrition combined with thyroid hormone replacement therapy for pregnant women with subclinical hypothyroidism.Methods:150 pregnant women with subclinical hypothyroidism were selected and divided into two groups according to the number random table method from January 2018 to March 2020.75 women in control group were given iodine nutrition,and 75 women in observation group were given iodine nutrition combined with thyroid hormone replacement therapy.The changes of thyroid function indexes levels and pregnancy outcomes of the women were compared between the two groups.Results:During 32 gestational weeks,the level of serum free thyroxine 4(FT4)(9.80±2.63 pmol/L)of the women in the observation group was significant higher than that(8.10±2.49 pmol/L)of the women in the control group,and the level of thyroid stimulating hormone(TSH)(1.50±0.51 mIU/L)of the women in the observation group was significant lower than that(2.01±0.49 mIU/L)of the women in the control group.The variation coefficients of the values of 24h SBP(11.05±1.24mmHg)and 24h DBP(6.24±1.15mmHg)of the women in the observation group were significant lower than those(13.46±1.36mmHg and 7.36±1.20mmHg)of the women in the control group.The incidence of adverse pregnancy outcomes(4.0%)of the women in the observation group was significant lower that(13.3%)of the women in the control group(all P<0.05).There was no significant difference in the incidence of adverse outcomes(1.3%vs.4.0%)of perinatal infants between the two groups(P>0.05).During the treatment period,the women in both groups were able to tolerate.1 woman(1.3%)in the observation group had palpitation discomfort at the beginning of treatment,and which symptoms had disappeared after increasing the dosage of FT4,and then had no any discomfort after gradually increased the dosage of FT4.All the women in the control group had completed the treatment without any palpitation and other discomfort.Conclusion:Iodine nutrition combined with thyroid hormone replacement therapy for pregnant women with subclinical hypothyroidism can significantly improve their thyroid function,which can reduce the occurrence of adverse pregnancy outcomes with higher safety.