左旋甲状腺素治疗妊娠期亚临床甲状腺功能减退症疗效分析

目的探讨左旋甲状腺素治疗妊娠期亚临床甲状腺功能减退症(Subclinical hypothyroidism,SCH)的疗效。方法选取2010年2月至2012年1月江苏盛泽医院产科诊断为妊娠期SCH患者54例为SCH组,妊娠期甲状腺功能正常孕妇54例为正常组,同期经我院体检中心检测的育龄期甲状腺功能正常的女性54例为对照组。SCH组患者予以左旋甲状腺素,其他各组不做处理。观察SCH组治疗前与治疗后2个月、3组的叶酸水平及甲状腺功能,并加以对比;比较SCH组和正常组的妊娠结局情况、新生儿情况以及子女随访至3岁时的智力发育情况。结果治疗后SCH组患者的叶酸水平高于治疗前,血清促甲状腺激素(thyroid stimulating hormone,TSH)降低(P均0.05),血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)水平较治疗前无变化(P0.05);SCH组剖宫产率高于正常组(P0.05),而分娩周数和产后出血量两组比较差异无统计学意义(P0.05);两组新生儿中神经管畸形差异有统计学意义(P0.05),其他新生儿情况比较,差异均无统计学意义(P0.05);SCH组子女3岁时的智力发育与正常组比较差异无统计学意义(P0.05)。结论左旋甲状腺激素治疗SCH,可有效增加叶酸水平,降低TSH含量,对妊娠结局产生积极影响,并可改善后代子女的生长发育情况。

Observation on the effect of levothyroxine for pregnant patients with subclinical hypothyroidism

Objective To explore the effect of levothyroxine for pregnant patients with subclinical hypothyroidism.Methods A total of 54 women with subclinical hypothyroidism in Jiangsu Shengze Hospital affiliated of Nanjing Medical University from Feb 2010 to Jan 2012 were selected into SCH group,54 healthy pregnant women in the same period were selected into control group,54 fertile women with normal thyroid in the same period were selected into normal group.The patients in SCH group were treatment with levothyroxine.The levels of folate and thyroid function were detected before and 2 months after treatment.The pregnant outcomes,neonatal conditions and the intellectual development of all the women's offspring by 3 years old were compared between SCH group and control group.Results In SCH group patients,folate concentration significantly increased,but the level of thyroid-stimulating hormone level significantly decreased after treatment (both P ＜ 0.05),free triiodothyronine and free thyroid hormone level had no significant changes after treatment(both P ＞ 0.05).The incidence of cesarean section in SCH group were higher than that in the control group (P ＜ 0.05),delivery weeks and amount of bleeding postpartum had no significant difference (P ＞ 0.05).There were significant differences in neural tube defects between two groups(P ＜0.05),other newborn condition had no significant difference(P ＞0.05).There were no difference of mental development between SCH group and control group when their children were 3 years old.Conclusion Treatment with levothyroxine can significantly increase serum folate and reduce thyroid stimulating hormone,which might have a positive meaning for improving pregnancy outcome,is worth spreading.