左甲状腺素治疗妊娠期亚临床甲状腺功能减退症有效性的Meta分析

目的系统评价左甲状腺素(L-T4)治疗妊娠期亚临床甲状腺功能减退症(SCH)的有效性。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、维普和万方数据库,搜集L-T4治疗妊娠期SCH的研究,采用RevMan 5.3软件进行统计分析。结果纳入26个随机对照试验共6475例患者。Meta分析结果显示:与对照组相比,L-T4组的早产(RR=0.51,95%CI:0.41~0.63)、死产(RR=0.16,95%CI:0.06~0.42)、胎儿生长受限(RR=0.41,95%CI:0.23~0.74)、低体重儿(RR=0.49,95%CI:0.29~0.84)、胎儿畸形(RR=0.12,95%CI:0.03~0.50)、胎儿窘迫(RR=0.36,95%CI:0.21~0.61)、新生儿窒息发生率(RR=0.24,95%CI:0.11~0.49)均显著降低;但新生儿Apgar评分两组差异无统计学意义(MD=0.10,95%CI:-0.01~0.20)。结论L-T4治疗妊娠期SCH可改善妊娠及新生儿不良结局。

Effectiveness of levothyroxine for subclinical hypothyroidism in pregnancy:a Meta-analysis

Objective To systematically review effectiveness of levothyroxine for subclinical hypothyroidism diagnosed in pregnancy.Methods Databases were searched to collect studies about levothyroxine therapy in pregnant women with subclinical hypothyroidism,including PubMed,EMbase,Cochrane Library,Web of Science,CBM,CNKI,VIP and Wangfang databases.Meta-analysis was performed by using RevMan 5.3 software.Results A total of 26 RCTs involving 6475 patients were included.The Meta-analysis showed that compared with control groups,L-T4 could significantly decreased the incidence of preterm delivery(RR=0.51,95%CI:0.41-0.63),stillbirth(RR=0.16,95%CI:0.06-0.42),intrauterine growth restriction(RR=0.41,95%CI:0.23-0.74),lower birth weight(RR=0.49,95%CI:0.29-0.84),congenital malformations(RR=0.12,95%CI:0.03-0.50),fetal distress(RR=0.36,95%CI:0.21-0.61)and asphyxia neonatorum(RR=0.24,95%CI:0.11-0.49);however,there was no significant difference in neonatal Apgar score between two groups(MD=0.10,95%CI:-0.01-0.20).Conclusion L-T4 showed beneficial effects in pregnancy and neonatal outcomes among women with subclinical hypothyroidism diagnosed in pregnancy.