妊娠合并亚临床甲状腺功能减退孕妇的妊娠结局

Pregnancy outcomes in pregnant women with subclinical hypothyroidism

目的探讨妊娠合并亚临床甲状腺功能减退(以下简称为“甲减”)孕妇的妊娠结局。方法选择2021年1月至2022年12月北京市顺义区医院收治的97例妊娠合并亚临床甲减患者为研究对象,按照孕期是否接受干预治疗,将其分为干预组(n=62,口服左甲状腺素钠干预治疗)和对照组(n=35,未服用左甲状腺素钠)。对2组孕妇治疗前、治疗后2周、治疗后6周、分娩前促甲状腺激素(TSH)、游离甲状腺激素(FT4)、总甲状腺素(TT4)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,以及不良妊娠结局等进行统计学比较。本研究遵循的程序符合北京市顺义区医院伦理委员会制定的伦理学标准,得到该委员会批准(伦审号:2024-L-011),2组孕妇的治疗方案,均取得受试者本人及其家属知情同意。结果①2组孕妇的年龄、人体质量指数(BMI)、孕龄、民族构成比、孕次、产次等一般临床资料比较,差异均无统计学意义(P>0.05)。②对2组孕妇治疗前、治疗后2周与6周及分娩前血清TSH、FT4和TT4水平,进行重复测量资料方差分析显示,不同治疗措施与时间因素的交互效应,差异均有统计学意义(F_(治疗×时间)=18.49、15.88、13.06,P_(治疗×时间)均<0.001)。③对2组孕妇治疗前、治疗后2周与6周及分娩前TPOAb、TgAb水平进行重复测量资料方差分析显示,不同治疗措施与时间因素的交互效应,差异均有统计学意义(F_(治疗×时间)=21.06、19.48,P_(治疗×时间)均<0.001)。④对2组孕妇治疗前、治疗后2周与6周及分娩前TC、TG、LDL-C和HDL-C水平进行重复测量资料方差分析显示,不同治疗措施与时间因素的交互效应,差异均无统计学意义(F_(治疗×时间)=0.51、0.76、0.62、0.85,P_(治疗×时间)=0.600、0.244、0.594、0.153)。⑤干预组孕妇先兆流产及胎膜早破(PROM)发生率,均低于对照组,并且差异均有统计学意义(P<0.05)。⑥2组宫内胎儿生长受限、新生儿窒息、早产发生率比较,差异无统计学意义(P>0.05)。结论妊娠合并亚临床甲减者给予左甲状腺素钠干预,能改善妊娠期亚临床甲减状态,降低甲状腺组织的自身免疫性抗体水平,减少先兆流产、PROM发生率。

Objective To investigate the pregnancy outcomes in pregnant women with subclinical hypothyroidism.Methods A total of 97 pregnant women with subclinical hypothyroidism admitted to Beijing Shunyi District Hospital from January 2021 to December 2022 were selected in this study.They were divided into intervention group(n=62,treated with levothyroxine sodium)and control group(n=35,not taking levothyroxine sodium)based on whether they received intervention treatment during pregnancy.The levels of thyroid-stimulating hormone(TSH),free thyroxine(FT4),total thyroxine(TT4),thyroid peroxidase antibodies(TPOAb),thyroglobulin antibodies(TgAb),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)before treatment,two and six weeks after treatment,and before delivery,as well as adverse pregnancy outcomes,were compared between two groups.The procedures followed in this study were in accordance with the ethical standards set by the Ethics Committee of the Beijing Shunyi District Hospital and were approved by the committee(Approval No.2024-L-011).Informed consents were obtained from all participants.Results①There were no statistically significant differences in general clinical data such as age,body mass index(BMI),gestational age,ethnic composition,gravidity,and parity between two groups(P>0.05).②Repeated measures analysis of variance of serum TSH,FT4,and TT4 levels before treatment,two weeks and six weeks after treatment,and before delivery between two groups showed that effect of different treatment measures and time factors was statistically significant(F_(treatment×time)=18.49,15.88,13.06;P_(treatment×time) all<0.001).③Analysis of variance of repeated measurement data of variance of TPOAb and TgAb levels before treatment,two weeks and six weeks after treatment,and before delivery between two groups showed that effect of different treatment measures and time factors was statistically significant(F_(treatment×time)=21.06,19.48;P_(treatment×time) all<0.001).④Analysis of variance of repeated measurement data of TC,TG,LDL-C,and HDL-C levels before treatment,two weeks and six weeks after treatment,and before delivery between two groups showed that effect of different treatment measures and time factors was not statistically significant(F_(treatment×time)=0.51,0.76,0.62,0.85;P_(treatment×time)=0.600,0.244,0.594,0.153).⑤The incidence of threatened abortion and premature rupture of membranes(PROM)were lower in intervention group than those in control group,and there were statistically significant differences between two groups(P<0.05).⑥There were no statistically significant differences in incidence of intrauterine fetal growth restriction,abortion,and preterm birth between two groups(P>0.05).Conclusions Intervention with levothyroxine sodium in pregnant women with subclinical hypothyroidism can improve subclinical hypothyroidism state during pregnancy,reduce levels of autoimmune antibodies in thyroid tissue,and decrease incidence of threatened abortion and PROM.