妊娠期甲状腺功能减退对妊娠结局的影响及左旋甲状腺素替代的价值

Effect of hypothyroidism during pregnancy on pregnancy outcome and value of levothyroxine replacement

目的探讨妊娠期甲状腺功能减退对妊娠结局的影响及左旋甲状腺素替代的价值。方法选取2018年1月~2020年6月在徐州医科大学附属邳州市人民医院进行产前检查的2880例孕妇,对其进行甲功检查,确诊甲状腺功能减退给予左旋甲状腺素治疗,TSH控制在0.3~2.5 mIU/L之间的80例为观察组,TSH>2.5 mIU/L的39例为对照组,按照1:2选择238例正常孕妇作为对比(正常组)。结果2880例孕妇中甲状腺功能减退119例,80例规范治疗,未规范治疗39例。三组间产科并发症比较,差异有统计学意义(P<0.05),对照组产科并发妊高症高于观察组(P<0.05),观察组与正常组产科并发症比较,差异无统计学意义(P>0.05)。三组间围生儿情况比较,差异有统计学意义(P<0.05);对照组早产率为7.69%、窒息及病死率为5.13%、胎儿窘迫率为7.69%、生长受限率为10.26%,高于观察组的5.00%、1.25%、1.25%、1.25%(P<0.05),观察组与正常组围生儿情况比较,差异无统计学意义(P>0.05)。结论甲减症是妊娠期常见的内分泌疾病,可引起产科及胎儿合并症增加,甲状腺素替代治疗疗效确切,可降低产科并发症发生概率,改善妊娠结局,具有良好的临床可行性。

Objective To explore the effect of hypothyroidism during pregnancy on pregnancy outcome and the value of levothyroxine replacement.Methods A total of 2880 pregnant women receiving prenatal examination in Pizhou People′s Hospital Affiliated to Xuzhou Medical University from January 2018 to June 2020 underwent thyroid function examination.Hypothyroidism was diagnosed and then treated with levothyroxine.80 patients with thyrotropin(TSH)controlled between 0.3-2.5 mIU/L were included in the observation group,and 39 cases with TSH greater than 2.5 mIU/L were included in the control group.238 normal pregnant women were selected as control subjects(the normal group)according to the ratio of 1:2.Results Among 2880 pregnant women,there were 119 cases of hypothyroidism,including 80 cases receiving standard treatment and 39 cases receiving non-standard treatment.There was a significant difference in obstetric complications among the three groups(P<0.05).The incidence of obstetric complications in the control group was higher than that in the observation group(P<0.05).There was no significant difference in obstetric complications between the observation group and the normal group(P>0.05).There was a significant difference in perinatal conditions among the three groups(P<0.05).The premature birth of 7.69%,asphyxia and death of 5.13%,fetal distress of 7.69%and growth restriction of 10.26%in the control group were higher than those of 5.00%,1.25%,1.25%and 1.25%in the observation group(P<0.05).There was no difference in perinatal conditions between the observation group and the normal group(P>0.05).Conclusion Hypothyroidism is a common endocrine disease during pregnancy,which can increase the occurrence of obstetric and fetal complications.Thyroxine replacement therapy shows definite curative effects and can reduce the probability of obstetric complications and improve pregnancy outcomes,which has good clinical feasibility.