妊娠母体亚临床甲状腺功能异常对妊娠结局的影响

目的观察妊娠期亚临床甲减以及甲状腺激素（TH）干预治疗对妊娠结局的影响。方法收集我院产科2008年1月——2011年12月四年间产前检查的孕妇临床病历资料1236例,亚临床甲减孕妇又分为：观察组（n=204）和左旋甲状腺素干预治疗组（n=92）。促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）和甲状腺素（T4）的检测使用放射免疫法。940例非妊娠期亚临床甲减孕妇为对照组。结果 1236例孕妇亚临床甲减296例,发生率为2.4%。正常妊娠对照组、观察组和干预组糖代谢异常的发生率分别为9.1%、16.2%和10.8%;贫血的发生率三组分别为10.9%、19.1%和12.0%;自发性流产的发生率分别为3.9%、8.8%和4.3%;新生儿的平均体重三组分别为（3.38±0.42）、（3.12±0.32）kg和（3.34±0.39）kg,统计学分析显示上述指标观察组显著高于对照组和干预组（P〈0.05）,对照组和干预组之间无统计学差异（P〉0.05）。孕周、高血压和剖宫产的发生率在三组之间无统计学差异（P〉0.05）。结论亚临床甲减孕妇具糖代谢异常、贫血、自发性流产和新生儿低体重的发生率较高,甲状腺激素的干预治疗可以减少上述并发症的发生。

The effect of subclinic hypothyroidism on pregnant outcome

Objective To investigate the effect of subclinic hypothyroidism on pregnant outcome and its prevention. Methods A total of 1236 pregnancy women were enrolled in this study. Pregnancy women with subclinic hypothyroidism were devided into two groups：observation group（n=204） and L-T4 intervention group（n=92）. RIA analysis was used to determine the serum level of TSH, T3, and T4. 940 cases of non- hypothyroidism were used as control. Results In the total 1236 cases, 296 cases were subclinic hypothyroidism with a rate of 2.4%. In control, observation, and intervention group, the incidence of abnomal glucose metabolism was 9.1, 16.2, and 10.8%; the incidence of anemia was 10.9,19.1, and 12.0%; the incidence of spontaneous abortion was 3.9, 8.8, and 4.3%; the average weight of newborns was（3.38±0.42）,（3.12±0.32）kg and（3.34±0.39）kg, respectively. Statistical analysis showed that these indicators in observation group was significantly higher than that in the control and intervention group（P〈0.05）. No significant difference was found between the control and intervention group（P〉0.05）. There was no significant difference in gestational age, the incidence of hypertension and cesarean section among the three groups（P〉0.05）. Conclusion Pregnant women with subclinical hypothyroidism have a high incidence of abnomal glucose metabolism, anemia, spontaneous abortion and low birthweight, and those clinical application can be intervented by thyroid hormone treatment.