妊娠合并甲状腺功能亢进症55例临床分析

目的探讨妊娠合并甲状腺功能亢进症的母儿结局和临床处理。方法回顾性分析2003年1月至2007年12月在我院住院分娩的55例妊娠合并甲状腺功能亢进症患者的临床资料，将其分为病情控制组（37例）和病情未控制组（18例），并进行对照研究。结果妊娠合并甲状腺功能亢进症发生率5．4‰，病情控制组／病情未控制组妊娠糖尿病、妊娠高血压疾病、甲亢性心脏病、引产、早产、流产、小于胎龄儿、死胎发生率分别为2．7％／38．9％、0％／27．8％、0％／27．8％、0％／22．2％、2．7％／50．0％、0％／16．7％、8．1％／44，4％、0％／27，8％，病情控制组明显低于病情未控制组（P〈0．01或0．05）；无孕产妇死亡，无新生儿出生缺陷。病情未控制组患者的医疗费用显著高于病情控制组（P〈0．001）。以丙基硫氧嘧啶为主的药物治疗安全有效。结论妊娠合并甲状腺功能亢进症孕前和孕期及早发现并规范治疗，并监测以FT3、FT4为主而非TSH的甲状腺功能，维持其正常、稳定，可以有效减少母儿并发症的发生。

Clinical Analysis of 55 Cases of Pregnancy with Hyperthyroidism

Objective To investigate the clinical outcome and the management of pregnancy with hyperthyroidism. Methods 55 cases of pregnancy with hyperthyroidism from Jan 2003 to Dec 2007 were retrospectively analyzed. Patients were divided into two groups： the disease-controlled group （37 cases） and the disease uncontrolled group （18 cases）. Results The rate of pregnancy with hyperthyroidism was 5.4‰. The incidence of gestational diabetes, pregnancy-induced hypertension disease, hyperthyroid heart disease, induced labor, premature birth, abortion, small for gestational age infants and stillbirth in the disease-controlled group/the disease uncontrolled group was 2.7%/38.9%, 0%/27.8%, 0%/27.8%, 0%/22.2%, 2.7%/50.0%, 0%/16.7%, 8.1%/44.4%, and 0%/ 27.8%, respectively. The incidence of complications in the disease-controlled group was lower than the disease uncontrolled group （P 〈 0.05）. Maternal mortality or birth defect was not recorded. The medical cost for the disease uncontrolled group was high than the disease controlled group （P 〈0.001 ）. Propylthiouracil was found to be safe and effective in these patients. Conclusion Before and during pregnancy, FT3 and FT4 should be monitored and maintained in the normal range. Early detection and treatment of pregnant women with hyperthyroidism may reduce maternal and fetal complications.