亚临床甲状腺功能减退症与自然流产史的关系探讨

目的探讨亚临床甲状腺功能减退症（亚甲减）与自然流产史的相关性及治疗亚甲减对降低自然流产率的作用。方法2011年1月—2012年12月在浙江省绍兴市妇幼保健院生殖中心就诊的210例早孕期妇女作为研究对象，其中复发性流产史患者50例作为A组，有1次自然流产史患者80例为B组，无自然流产史患者80例为C组。用电化学发光法检测促甲状腺素（TSH）、游离甲状腺素（FT4）。用左旋甲状腺素片（优甲乐）进行治疗。结果A组、B组、C组患者的年龄分别为（28．5±4．7）岁、（27．9±3．9）岁和（29．2±4．1）岁，3组年龄均符合正态分布，差异无统计学意义（x2=2．246，P〉0．05）。亚甲减患病率A组为26．00％，B组为18．75％，C组为5．00％。A组和B组亚甲减患病率差异无统计学意义，A组和B组亚甲减患病率均高于C组，差异有统计学意义（Pearson x2=11．740，P〈0．05）。经过左旋甲状腺素片（优甲乐）治疗后，A组流产率为23．08％，B组13．33％，而C组无1例流产。C组流产率明显低于A组和B组，提示亚甲减与妊娠不良结局具有一定相关性。结论亚甲减与自然流产有明显相关性，但亚甲减经过左旋甲状腺素治疗后可降低再次流产的发生率。

The relationship between subclinical hypothyroidism and history of spontaneous abortion

Objective To investigate the relationship between subclinical hypothyroidism and history of spontaneous abortion and the significance of treating subclinical hypothyroidism to reduce the spontaneous abortion ratio. Methods 210 cases of pregnant women in the first trimester were studied between January 2011 and December 2012 in Department of Reproductive Center,50 cases of recurrent miscarriage women were taken as group A ,80 cases of primary spontaneous abortion women were taken as group B, 80 cases of no abortion women were taken as group C. Electrochemiluminescence （ECL） assay was used for checking thyrotropin（ TSH）, free thyroxine（FT4）. Levothyroxine was taken for treatment. Results The mean age of Group A, Group B, Group C patient age was （ 28.5 ± 4.7 ） years, （ 27.9± 3.9 ） years and （29.2 ± 4.1 ） years , the age of three groups were normally distributed, no significant difference （X2 = 2. 246, P 〉 0.05 ）. The morbidity rate of subclinical hypothyroidism of group A was 26% ,group B was 18.75% and group C was 5%. There was of no significant difference of morbidity rate between group A and B. The morbidity rates of group A and B were both higher than group C, the difference was significant （ Pearson X2 = 11. 740,P 〈 0.05 ）. After levothyroxine treatment, the abortion rate of group A was 23.08% ,and group B was 13.33% ,while there was no case abortion in group C. The abortion rate of group C was significantly lower than that of group A and group B, that showed subclinical hypothyroidism was associated with poor pregnancy outcomes. Conclusion Subclinical hypothyroidism was associated with history of spontaneous abortion, but treating subclinical hypothyroidism with Levothyroxine can reduce the incidence of abortion once again.