大剂量与小剂量左甲状腺素治疗妊娠合并甲状腺功能减退症患者的效果比较

Comparison of effects of high-dose and low-dose levothyroxine in treatment of pregnant patients with hypothyroidism

目的:比较大剂量与小剂量左甲状腺素治疗妊娠合并甲状腺功能减退症(简称甲减)患者的效果。方法:选取88例妊娠合并甲减患者为研究对象,按照随机数字表法分为对照组和观察组各44例。对照组给予小剂量左甲状腺素钠片治疗,观察组给予大剂量左甲状腺素钠片治疗。比较两组治疗前后甲状腺功能指标[促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT_(3))、抗甲状腺过氧化物酶自身抗体(TPOAb)]水平、不良妊娠结局发生率、不良反应发生率和新生儿发育[智能发育指数(MDI)及运动发育指数(PDI)]评分。结果:治疗后,两组TSH、TPOAb水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组FT_(3)水平均高于治疗前,但两组间比较,差异无统计学意义(P>0.05);观察组妊娠不良结局发生率为18.18%,明显低于对照组的38.64%,差异有统计学意义(P<0.05);观察组不良反应发生率为18.18%,明显高于对照组的2.27%,差异有统计学意义(P<0.05);观察组新生儿MDI、PDI评分均高于对照组,差异均有统计学意义(P<0.05)。结论:大剂量左甲状腺素钠片治疗妊娠合并甲减患者可改善甲状腺功能指标水平,降低不良妊娠结局率,以及提高新生儿发育评分的效果优于小剂量左甲状腺素钠片治疗,但大剂量左甲状腺素钠片治疗的不良反应发生率较高。

Objective:To compare effects of high-dose and low-dose levothyroxine in treatment of pregnant patients with hypothyroidism.Methods:88 pregnant patients with hypothyroidism were selected as the research objects and were divided into control group and observation group according to the random number table method,44 cases in each.The control group was treated with low-dose Levothyroxine sodium tablets,while the observation group was treated with high-dose Levothyroxine sodium tablets.The levels of thyroid function index[thyrotropin(TSH),free triiodothyronine(FT_(3)),anti-thyroid peroxidase autoantibody(TPOAb)]levels,the incidence of adverse pregnancy outcomes,the incidence of adverse reactions and the neonatal development[mental development index(MDI)and psychomotor development index(PDI)]scores were compared between the two groups before and after the treatment.Results:After the treatment,the levels of TSH and TPOAb in the two groups were lower than those before the treatment;those of the observation group were lower than those of the control group;and the differences were statistically significant(P<0.05).The levels of FT_(3) in the two groups were higher than those before the treatment;however,there was no significant difference between the two groups(P>0.05).The total incidence of adverse pregnancy outcomes in the observation group was 18.18%,which was significantly lower than 38.64% in the control group,and the difference was statistically significant(P<0.05).The adverse reaction rate in the observation group was 18.18%,which was significantly higher than the control group of 2.27%,and the difference was statistically significant(P<0.05).Further,the MDI and PDI scores of neonates in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:High-dose Levothyroxine sodium tablets in the treatment of the pregnant patients with hypothyroidism can improve the levels of thyroid function indexes,reduce the adverse pregnancy outcome rate,and improve the neonatal development score.Moreover,it is superior to low-dose Levothyroxine sodium tablets.However,high-dose levothyroxine sodium tablets in the treatment can increase the adverse reaction rate.