左甲状腺素治疗妊娠合并甲状腺功能低下在孕早期和孕中期的效果比较

Comparison of the efficacy of levothyroxine treatment in the early and mid-term pregnancy for pregnant women with subclinical hypothyroidism

目的探讨孕早期和孕中期左甲状腺素治疗(LT)妊娠合并甲状腺功能低下的疗效比较。方法观察湘南学院附属医院妇产科2020年1月至2022年10月期间100例亚临床甲减孕妇,并将受试者1∶1分配到孕早期LT组和孕中期LT组,每组50例。孕早期LT组在诊断为亚临床甲减的第2天(8~10周)接受LT干预。孕中期LT组在妊娠中期(13~16周)随访时进行LT干预。通过化学发光免疫法测定空腹血样中TSH、FT4和FT3水平。比较两组的妊娠并发症、妊娠结局。结果孕早期LT组和孕中期LT组孕妇登记时的怀孕持续时间分别为(57.88±12.20)d和(58.78±10.08)d。与治疗前相比,两组经LT治疗后(分娩前)的血清TSH水平显著降低(P<0.05),而两组间比较差异无统计学意义(P>0.05)。此外,两组血清FT3、FT4水平在治疗前后及组间比较差异均无统计学意义(P>0.05)。与孕早期LT组相比,孕中期LT组流产、妊娠高血压和新生儿入住NICU风险显著增加(P<0.05)。控制TPOAB阳性与否的影响后,流产、妊娠高血压和新生儿入住NICU与孕中期LT组密切相关(P<0.05)。结论LT开始治疗亚临床甲减的时间可能会影响预防不良妊娠结局的效果,即孕早期LT干预有助于降低流产、妊娠高血压和新生儿入住NICU的发生。

Objective To compare the efficacy of levothyroxine treatment(LT)in early and mid-term pregnancy for pregnant women with subclinical hypothyroidism.Methods A total of 100 cases of subclinical hypothyroidism in pregnant women were observed at the Department of Obstetrics and Gynecology of the Affiliated Hospital of Xiangnan University from January 2020 to October 2022.The subjects were divided into early pregnancy LT group and mid-term pregnancy LT group at a ratio of 1∶1,with 50 cases in each group.The early pregnancy LT group received LT intervention on the second day of subclinical hypothyroidism diagnosis(8-10 weeks).The mid-term pregnancy LT group received LT intervention during mid-pregnancy(13-16 weeks)follow-up.The levels of TSH,FT4,and FT3 in fasting blood samples were determined by chemiluminescent immunoassay.Pregnancy complications and outcomes were compared between the two groups.Results The duration of pregnancy at registration was(57.88±12.20)days in the early pregnancy LT group and(58.78±10.08)days in the mid-term pregnancy LT group.Compared with before treatment,the serum TSH levels significantly decreased in both groups after LT treatment(before delivery)(P<0.05),with no statistically significant difference between the two groups(P>0.05).Additionally,there were no significant differences in serum FT3 and FT4 levels before and after treatment,as well as between the two groups(P>0.05).Compared with the early pregnancy LT group,the mid-term pregnancy LT group showed a significant increase in the risks of miscarriage,pregnancy-induced hypertension,and neonatal admission to the NICU(P<0.05).After controlling for the impact of TPOAB positivity,miscarriage,pregnancy-induced hypertension,and neonatal admission to the NICU were closely related to the mid-term pregnancy LT group(P<0.05).Conclusion The timing of initiating LT treatment for subclinical hypothyroidism may influence the prevention of adverse pregnancy outcomes.Early pregnancy LT intervention may help reduce the occurrence of miscarriage,pregnancy-induced hypertension,and neonatal admission to the NICU.