左旋甲状腺素治疗妊娠期糖尿病伴亚临床甲减孕妇的临床效果分析

Analysis of the clinical effect of levothyroxine in the treatment of pregnant women with gestational diabetes mellitus and subclinical hypothyroidism

目的分析妊娠期糖尿病(GDM)伴亚临床甲状腺功能减退症(甲减)孕妇采取左旋甲状腺素治疗的效果。方法66例GDM伴亚临床甲减孕妇,采用随机数字表法分为观察组和对照组,每组33例。对照组患者采取胰岛素治疗,观察组患者采取胰岛素联合左旋甲状腺素治疗。对比两组治疗前后甲状腺功能指标[促甲状腺激素(FSH)、血清游离甲状腺素(FT_(4))、游离三碘甲状腺原氨酸(FT_(3))]、血糖指标[餐后2 h血糖(2 h PBG)、空腹血糖(FPG)]以及并发症发生率、新生儿结局。结果治疗后,两组FT_(4)水平对比差异无统计学意义(P>0.05);观察组FT_(3)水平(6.77±0.78)pmol/L高于对照组的(5.01±0.49)pmol/L,FSH水平(3.26±1.07)mU/L低于对照组的(8.38±1.74)mU/L,差异具有统计学意义(P<0.05)。治疗后,观察组2 h PBG、FPG水平分别为(5.72±0.26)、(5.32±0.39)mmol/L,均低于对照组的(6.29±0.40)、(5.93±0.24)mmol/L,差异具有统计学意义(P<0.05)。观察组产后出血、胎膜早破、羊水异常、早产、前置胎盘、妊娠期蛋白尿、妊娠期高血压、贫血发生率分别为3.03%、6.06%、6.06%、3.03%、15.15%、3.03%、3.03%、3.03%,均低于对照组的18.18%、30.30%、24.24%、18.18%、45.45%、18.18%、18.18%、18.18%,差异具有统计学意义(P<0.05)。观察组死胎、胎儿畸形、低体重儿胎儿宫内窘迫发生率分别为0、3.03%、3.03%、3.03%,均低于对照组的15.15%、18.18%、21.21%、24.24%,差异具有统计学意义(P<0.05)。结论左旋甲状腺素在GDM伴亚临床甲减孕妇治疗中效果良好,可有效改善孕妇甲状腺功能指标及血糖水平,降低并发症发生率,改善新生儿结局。

Objective To analyze the effect of levothyroxine in the treatment of pregnant women with gestational diabetes mellitus(GDM)and subclinical hypothyroidism.Methods A total of 66 pregnant women with GDM and subclinical hypothyroidism were divided into observation group and control group according to random numerical table,with 33 cases in each group.Patients in the control group were treated with insulin,and patients in the observation group were treated with insulin combined with levothyroxine.Both groups were compared in terms of thyroid function indexes[follicle stimulating hormone(FSH),serum free thyroxine(FT_(4)),free triiodothyronine(FT_(3))],blood glucose indexes[2 h postprandial blood glucose(2 h PBG),fasting plasma glucose(FPG)]before and after treatment,complication rate,and neonatal outcomes.Results After treatment,there was no statistically significant difference in the level of FT_(4) between the two groups(P>0.05).The level of FT_(3)(6.77±0.78)pmol/L in the observation group was higher than(5.01±0.49)pmol/L in the control group,and the level of FSH(3.26±1.07)mU/L was lower than(8.38±1.74)mU/L in the control group.All the differences were statistically significant(P<0.05).After treatment,the 2 h PBG and FPG levels in the observation group were(5.72±0.26)and(5.32±0.39)mmol/L,which were lower than(6.29±0.40)and(5.93±0.24)mmol/L in the control group,and the differences were statistically significant(P<0.05).The incidence rates of postpartum hemorrhage,premature rupture of membranes,abnormal amniotic fluid,premature birth,placenta previa,gestational proteinuria,gestational hypertension,and anemia in the observation group were 3.03%,6.06%,6.06%,3.03%,15.15%,3.03%,3.03%,and 3.03%,which were lower than 18.18%,30.30%,24.24%,18.18%,45.45%,18.18%,18.18%,and 18.18% in the control group,and the differences were statistically significant(P<0.05).The incidence rates of stillbirth,fetal malformation,and low birth weight infants,and fetal distress in the observation group were 0,3.03%,3.03%,and 3.03%,which were lower than 15.15%,18.18%,21.21%,and 24.24%in the control group,and the differences were statistically significant(P<0.05).Conclusion Levothyroxine has good effect in the treatment of pregnant women with gestational diabetes mellitus and subclinical hypothyroidism,and can effectively improve the thyroid function indexes and blood glucose levels of pregnant women,reduce the complication rate,and improve the neonatal outcome.