妊娠期甲状腺功能减退症的筛查及干预对妊娠结局的影响

目的：探讨妊娠期甲状腺功能减退（甲减）的筛查及干预对妊娠结局的影响。方法对3646例孕妇进行甲状腺功能减退症筛查，所有甲减患者均嘱接受L-T4替代治疗，其中44例患者严格遵医嘱进行了治疗（治疗组），另外23例则因多种原因未遵医嘱接受治疗（未治疗组）。对比两组患者的妊娠结局。结果3646例孕妇中67例诊断为甲减，妊娠期甲减发生率为1.8%，其中临床甲减28例，亚临床甲减39例。治疗组妊娠时间显著长于未治疗组（P＜0.01），胎儿窘迫、胎儿生长受限（FGR）发生率均显著低于未治疗组（P＜0.05），新生儿出生体重显著高于未治疗组（P＜0.01）；两组患者在早产率、妊娠期高血压疾病发生率、妊娠期糖代谢异常发生率及胎膜早破、死胎、流产、新生儿窒息发生率方面比较差异均无统计学意义（P＞0.05）。结论妊娠期甲状腺功能减退症的筛查能及时了解妊娠期妇女的甲状腺功能状态，对于甲状腺功能减退孕妇进行及时的治疗，可有效改善甲状腺功能状态，降低胎儿发育迟缓及其他不良妊娠结局的发生率。

Analysis of the influence on pregnancy outcome of hypothyroidism in pregnancy screening and intervention

Objective To discuss the influence on pregnancy outcome of hypothyroidism in pregnancy screening and intervention. Methods 3 646 pregnant women were screened for hypothyroidism, all patients with hy-pothyroidism were treated with levothyroxine repacement therapay, among them,44 patients diagnosed with hypothy-roidism were strictly prescribed for the treatment （the treated group） and 23 patients diagnosed with hypothyroidism were not trated with thyroid hormone replacement therapy for different reasons（the untreated group）, then the pregnan-cy outcomes were conpared between two groups. Results 67 cases were diagnosed with hypothyroidism in 3 646 pregnant women, the incidence was 1.8%, and there were 28 cases with clinical hypothyroidism, and 39 cases with subclinical hypothyroidism.In the treated group, the gestation time was significantly longer than the untreated group （P〈0.01）, and the incidence of fetal distress and FGR were significantly lower than the untreated group （P〈0.05）, the birth weight was significantly higher than the untreated group （P〈0.01）, but no significantly difference in the inci-dence of premature birth, gestational hypertension disease, prevalence of abnormal glucose metabolism during preg-nancy, premature rupture of membranes, stillbirth, miscarriage, neonatal asphyxia （P〉0.05）. Conclusion Screening of hypothyroidism during pregnancy can keep abreast of thyroid function of the pregnant women.The effective meth-ods to find hypothyroidism in pregnancy are early diagnosis and timely treatment, which can effectively improve the thyroid function status and reduce fetal growth retardation and other incidence of adverse pregnancy outcomes.