不同剂量左甲状腺素钠片治疗对妊娠期甲状腺功能减退症孕妇甲状腺激素妊娠结局及子代心理发育功能的影响研究

Study on the Effects of Different Doses of Levothyroxine Dodium Tablet Treatment on Thyroid Hormones,Pregnancy Outcome and Offspring Psychological Developmental Functions in Pregnant Women with Hypothyroidism During Pregnancy

目的:研究不同剂量左甲状腺素钠片治疗对妊娠期甲状腺功能减退症孕妇甲状腺激素及妊娠结局的影响。方法:选择本院2020年8月至2021年8月诊治的100例妊娠期甲减患者,均给予左甲状腺素钠片治疗,根据用药剂量分为A组(25ug/次,54例)、B组(50ug/次,25例)和C组(75ug/次,21例),对比三组患者的相关参数。结果:三组患者治疗前甲状腺功能各指标水平比较无统计学意义(P>0.05),治疗后三组促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPO-Ab)水平均显著降低,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均显著升高,C组患者升高或降低幅度显著高于A组、B组(P<0.05);治疗前三组患者糖脂代谢水平比较无统计学意义(P>0.05),治疗后三组空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、低密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)均低于治疗前,而高密度脂蛋白胆固醇(HDL-C)高于治疗前,且C组各指标变化幅度均大于A组、B组(P<0.05);三组妊娠期糖尿病、胎膜早破发生率差异有统计学意义(P<0.05),其中C组妊娠期糖尿病发生率明显低于A组(P<0.05),其余妊娠结局三组比较无统计学意义(P>0.05);C组患者子代大运动、适应能力、社会行为评分显著高于A组、B组(P<0.05),而语言、精细动作三组比较无统计学意义(P>0.05)。结论:相比于低剂量左甲状腺素钠片,高剂量可更好的维持妊娠期甲减患者甲状腺功能正常,调节糖脂代谢、降低不良妊娠风险,并改善子代神经、智力发育情况。

Objective:To study the effects of different doses of levothyroxine sodium tablets on thyroid hormones,pregnancy outcomes and offspring psychological development of women with hypothyroidism during pregnancy.Methods:A total of 100 pregnant women with hypothyroidism treated with levothyroxine sodium tablets in the hospital from August 2020 to August 2021 were selected.They were divided into group A(25ug/time,54 cases),group B(50ug/time,25 cases)and group C(75ug/time,21 cases)according to the dose.Relevant parameters in the three groups were comparatively analyzed.Results:Thyroid function indicators in the three groups showed no statistically significant difference before treatment(P>0.05).After treatment,the levels of thyroid stimulating hormone(TSH)and thyroid peroxidase antibody(TPO-Ab)were significantly decreased,and the levels of free triiodothyronine(FT3)and free thyroxine(FT4)were significantly increased in all groups.The increases or decreases were significantly greater in group C than in group A and group B(P<0.05).The glucose and lipid metabolism in the three groups showed no statistically significant difference before treatment(P>0.05).After treatment,fasting plasma glucose(FPG),fasting insulin(FINS),total cholesterol(TC),low-density lipoprotein cholesterol(HDL-C),and triglyceride(TG)were decreased,while high-density lipoprotein Cholesterol(HDL-C)was increased in the three groups.The changes in group C were greater than those in group A and group B(P<0.05).There were significant differences in the incidence rates of gestational diabetes mellitus and premature rupture of membranes among the 3 groups(P<0.05).The incidence of gestational diabetes mellitus in group C was significantly lower than that in group A(P<0.05).The other pregnancy outcomes of the 3 groups showed no statistically significant difference(P>0.05).The scores of offspring's gross motor,adaptability and social behavior in group C were significantly higher than those in group A and group B(P<0.05),but there was no statistically significant difference in language and fine motor(P>0.05).Conclusion:Compared with low-dose levothyroxine sodium tablets,high-dose levothyroxine sodium tablets can better maintain normal thyroid function in pregnant women with hypothyroidism,regulate their glucose and lipid metabolism,lower the risk of adverse pregnancy outcomes,and improve offspring's neuropsychological development.