妊娠合并甲状腺机能亢进255例临床分析

目的探讨妊娠合并甲状腺机能亢进患者的围产期发病率,药物治疗剂量及规范治疗后的母婴结局。方法收集我院1995年1月～2007年12月的妊娠合并甲亢患者的临床资料255例,分为控制组153例,未控制组102例,选择同期正常妊娠315例作为对照组,控制组均在我院产科高危门诊定期产前保健,每1～1.5月监测FT4,FT3,调整抗甲状腺药物（ATD）的剂量。对妊娠合并甲亢的发生率,控制组的抗甲状腺药物剂量以及3组母儿结局进行回顾性分析。结果（1）发病率：我院近13年来妊娠合并甲亢的发病率0.26%,呈逐年上升的趋势（0.17%～0.32%）。（2）抗甲状腺药物剂量（ATD）：控制组（116例）ATD的平均剂量孕前、孕早期、孕中晚期分别为：126.27±109.92,174.58±121.42,125.21±110.77,孕前与孕早期比较,差异有统计学意义（P〈0.05=;孕早期与孕中、晚期比较,差异有统计学意义（P〈0.05）;孕前与孕中、晚期比较,差异无统计学意义（P〉0.05）。（3）母婴结局：未控制组的子痫前期、早产、胎儿生长不良、胎儿窘迫发生率与控制组比较,差异有统计学意义,控制组与正常妊娠比较,差异无统计学意义。结论妊娠合并甲亢的发病率逐年升高,孕期需及时调整抗甲状腺药物治疗量,规律治疗能明显改善母儿结局。

Clinical analysis of hyperthyroidism during pregnancy in 255 cases

Objective：To evaluate the perinatal morbidity of maternal hyperthyroidism during pregnancy,maternal and fetal outcome with antithyroid drug（ATD）and its therapeutic dose.Methods：255 pregnancies with maternal hyperthyroidism were evaluated retrospectively from Jan 1995 to December2008 in The third affiliated hospital of wenzhou medical college were divided into two groups：ATD treatment group（153 cases）and without ATD treatment group（102 cases）,while 315 pregnancies without maternal hyperthyroidism were collected as control group.Study group were advice to antenatal care for monitoring FT3/FT4 and the adjustment of ATD in High-risk obstetric out-patient clinic every 11.5 months.The perinatal morbidity of maternal hyperthyroidism during pregnancy,maternal and fetal outcome with antithyroid drug（ATD）and its therapeutic dose in ATD treatment group were evaluated retrospectively.Results：1.The average perinatal morbidity of maternal hyperthyroidism during pregnancy was 0.26% in the past 13years,Showing a rising trend（from 0.17% to 0.32%）.2.Dose of antithyroid drug（ATD）：The average dose of Pre-pregnancy,early pregnancy,second and third trimesters are as follows：126.27±109.92,174.58±121.42,125.21±110.77,Pre-pregnancy were lower than early pregnancy（P〈0.05）;early pregnancy were higher than second and third trimesters（P〈0.05）;Pre-pregnancy were not difference with second and third trimesters（P〉0.05）.3.Maternal and fetal outcome：the incidence of Pre-eclampsia,prematurity,fetal growth and adverse,fetal distress in without ATD treatment group were significant differences with ATD treatment group.ATD treatment group were no significant differences with control group.Conclusion：The incidence of pregnancy with maternal hyperthyroidism were increased in the past 13years;pregnancy with maternal hyperthyroidism should be advice to antithyroid drug treatment and timely adjustment;the maternal and fetal outcome were significantly improved by regular treatment.