丙硫氧嘧啶、甲硫咪唑对妊娠期甲状腺功能亢进患者妊娠结局的影响比较

Comparison of the effects of propylthiouracil and methimazole on the pregnancy outcome of patients with hyperthyroidism during pregnancy

目的比较丙硫氧嘧啶、甲硫咪唑对妊娠期甲状腺功能亢进(甲亢)患者妊娠结局的影响。方法选取2017年1月至2020年12月广东省连山壮族瑶族自治县人民医院收治的妊娠期甲亢患者102例的临床资料进行回顾性分析研究,按治疗方式分为两组。其中51例接受丙硫氧嘧啶(PTU)治疗为PTU组,另51例接受甲硫咪唑(MMI)治疗为MMI组。比较治疗后两组甲状腺素水平[促甲状腺激素(TSH)、甲状腺素(T_(4))、游离甲状腺素(FT_(4))]、妊娠结局与母体不良反应。结果治疗后,PTU组TSH水平明显高于MMI组,T_(4)、FT_(4)水平明显低于MMI组,两组比较,差异有统计学意义(P<0.05);PTU组的早产、流产、胎儿窘迫、胎儿甲亢发生率明显低于MMI组,足月产率高于MMI组,差异均有统计学意义(均P<0.05);PTU组患者皮肤瘙痒、妊娠高血压、中性粒细胞减少等不良反应总发生率明显低于MMI组,差异有统计学意义(P<0.05)。结论PTU比MMI更有助于妊娠期甲亢患者甲状腺功能和妊娠结局的改善,且安全性更高。

Objective To compare the effects of propylthiouracil and methimazole on the pregnancy outcome of patients with hyperthyroidism(hyperthyroidism)during pregnancy.Methods A retrospective analysis of the clinical data of 102 patients with hyperthyroidism during pregnancy admitted to the People's Hospital of Lianshan Zhuang and Yao Autonomous County in Guangdong Province from January 2017 to December 2020.Among them,51 cases received propylthiouracil(PTU)treatment as PTU group,and the other 51 cases received methimazole(MMI)treatment as MMI group.After treatment,the levels of thyroxine[thyroid stimulating hormone(TSH),thyroxine(T4),free thyroxine(FT4)],pregnancy outcome and maternal adverse reactions were compared between the two groups.Results After treatment,the level of TSH in the PTU group was significantly higher than that of the MMI group,and T4 and FT4 were significantly lower than the MMI group.The difference between the two groups was statistically significant(P<0.05);the PTU group experienced premature delivery,miscarriage,neonatal fetal distress,and fetal distress in the PTU group.The incidence of hyperthyroidism was significantly lower than that of the MMI group,and the rate of full-term delivery was higher than that of the MMI group,and the differences were statistically significant(P<0.05);the total incidence of adverse reactions such as skin pruritus,pregnancy-induced hypertension,and neutropenia in the PTU group was Significantly lower than the MMI group,and the difference was statistically significant(P<0.05).Conclusion Propylthiouracil is more helpful than methimazole in the improvement of thyroid function and pregnancy outcome in patients with hyperthyroidism during pregnancy,and it is safer.