妊娠合并亚临床型甲状腺功能减退孕妇的分娩结局研究

目的分析妊娠合并亚临床型甲状腺功能减退(subclinical hypothyroidism,SCH)孕妇的分娩结局,探讨孕妇血清甲功检测与新生儿甲功检测的关系。方法选取2014年6月至2015年5月在江苏盛泽医院妇产科就诊的妊娠合并SCH患者92例。根据是否接受左旋甲状腺素片治疗分为治疗组45例和观察组47例,选择同期就诊的正常孕妇55例作为对照组,比较3组妊娠并发症的发生率和妊娠后胎儿的各项指标;并分析观察组孕妇血清促甲状腺激素(thyroid stimulating hormone,TSH)、血清游离甲状腺素(free thyroxine,FT4)与新生儿脐血TSH、FT4的相关性。结果观察组孕妇羊水过多(17.02%,8/47)、妊娠高血压(27.66%,13/47)、胎膜早破(23.40%,11/47)和剖宫产发生率(27.79%,14/47)高于治疗组和对照组,差异有统计学意义(P0.05)。观察组新生儿出生体重(2 714.14±467.25)g、Apgar评分(8.27±1.49)低于治疗组和对照组,差异有统计学意义(P0.05)。观察组低出生体重儿发生率(17.02%,8/47)和小于胎龄儿发生率(27.66%,13/47)高于治疗组和对照组,差异有统计学意义(P0.05)。观察组孕妇血清中的TSH含量与新生儿脐血中的TSH含量呈正相关(r=0.352,P=0.015);孕妇血清中的FT4含量与新生儿脐血中的FT4含量呈负相关(r=-0.408,P=0.004)。结论妊娠合并SCH孕妇如不进行药物干预,则不良妊娠结局的发生率高于正常孕妇和治疗孕妇,孕妇血清甲功检测与新生儿甲功检测密切相关。

Study on delivery outcomes of pregnant women with subclinical hypothyroidism

Objective To analyze the delivery outcomes of pregnant women with subclinical hypothyroidism ( SCH ) , and to explore the relationship between the detection of neonatal thyroid function and thyroid function of pregnant women. Methods 92 pregnant women complicated with SCH treated in Shengze hospital of Jiangsu from June 2014 to May 2015 were selected, according to whether recieved Levothyroxine Sodium (LT4) treatment,they were divided into treatment group (n= 45)and observation group (n=47). 55 cases of normal pregnant women in the same period were selected as the control group. Compared the incidence of pregnancy complications and the fetal indexes of the three groups; and the relationship between TSH and FT4 of pregnant woman and those of neonatal in the observation group was analyzed. Results The incidence of hydramnion(17. 02 %,8/47),gestational hypertension (27. 66 %,13/47),premature rupture of fetal membranes (23. 40 %,11/47) and cesarean delivery rate(27. 79 %,14/47) of the observation group were higher than those of the treatment group and the control group(P<0. 05). The average birth weight (2 714. 14 ± 467. 25)g, Apgar score(8. 27 ± 1. 49) in the observation group were lower than those in the treatment group and the control group(P<0. 05). The incidence of low birth weight infants (17. 02 %,8/47) and small for gestational age infants(27. 66 %,13/47) of the observation group were significantly higher than those of the treatment group and control group (P<0. 05). In the observation group, the thyroid stimulating hormone ( TSH) in serum of pregnant women were positively correlated with TSH in the neonatal cord blood( r=0. 352,P=0. 015), and the free thyroxine(FT4) in serum of pregnant women were negatively correlated with FT4 in the neonatal cord blood (r= -0. 408,P=0. 004). Conclusion The incidence of adverse pregnancy outcomes in pregnant women with SCH was higher than that in normal pregnancy if not given active drug intervention, and the serum thyroid function in pregnant women was closely related to the neonatal cord blood thyroid function.