不同剂量左甲状腺素钠片对妊娠期亚临床甲状腺功能减退症临床疗效及甲状腺激素水平的影响

Effect of different doses of levothyroxine sodium tablets on clinical efficacy and thyroid hormone levels in subclinical hypothyroidism during pregnancy

目的探讨不同剂量左甲状腺素钠片治疗妊娠期亚临床甲状腺功能减退症(甲减)的效果及对患者甲状腺激素水平的影响。方法选取瑞金市妇幼保健院2022年1月至2022年12月收治的88例妊娠期亚临床甲减患者作为研究对象,按照随机数字表法分为观察组与对照组,每组44例。对照组给予25μg/d左甲状腺素钠片治疗,观察组给予75μg/d左甲状腺素钠片治疗,比较两组临床疗效、甲状腺激素[促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)]水平、不良反应发生情况、不良妊娠结局发生率及新生儿Apgar评分。结果观察组治疗总有效率为97.27%,高于对照组的75.00%,差异有统计学意义(P<0.05)。治疗后2、4、8、12周,两组血清TSH和FT3水平均低于前一时间点,血清FT4水平均高于前一时间点,且观察组血清TSH和FT3水平均低于对照组,血清FT4水平均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.54%,低于对照组的27.57%,差异有统计学意义(P<0.05)。观察组不良妊娠结局发生率低于对照组,新生儿Apgar评分高于对照组,差异有统计学意义(P<0.05)。结论高剂量左甲状腺素钠片治疗妊娠期亚临床甲减的疗效更显著,可改善患者甲状腺激素水平,降低不良反应及不良妊娠结局发生率,改善新生儿预后。

Objective To investigate the effects of different doses of levothyroxine sodium tablets in the treatment of subclinical hypothyroidism during pregnancy and the influence on thyroid hormone levels.Methods 88 patients with subclinical hypothyroidism during pregnancy admitted to Ruijin maternal and child health care hospital from January 2022 to December 2022 were selected as research subjects,and they were divided into the observation group and the control group according to random number table method,with 44 cases in each group.The control group was treated with 25μg levothyroxine sodium tablets,and the observation group was treated with 75μg levothyroxine sodium tablets,the clinical efficacy,the levels of thyroid hormone(thyroid stimulating hormone[TSH],free thyroxine[FT4]and free triiodothyronine[FT3]),incidence of adverse reactions,incidence of adverse pregnancy outcome and neonatal Apgar score were compared between the two groups.Results The total effective rate in the observation group was 97.27%,which was higher than 75.00%in the control group,and the difference was statistically significant(P<0.05).At 2,4,8,12 week after treatment,the serum TSH and FT3 levels of the two groups were lower than at the previous time points,and the serum FT4 level were higher than at the previous time points,and the serum TSH and FT3 levels in the observation group were lower than those in the control group,and the serum FT4 level was higher than that in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 4.54%,which was lower than 27.57%in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse pregnancy outcome in the observation group was lower than that in control group,and the neonatal Apgar score was higher than that in control group,the differences were statistically significant(P<0.05).Conclusion High dose of levothyroxine sodium tablets is more effective in the treatment of subclinical hypothyroidism during pregnancy,which can improve thyroid hormone levels,reduce the incidence of adverse reactions and adverse pregnancy outcomes,and improve neonatal prognosis.