妊娠合并甲状腺功能低减患者的临床分析

目的 探讨妊娠合并甲状腺功能低减(甲减)患者的围产期发病率、药物治疗剂量及母婴结局.方法 收集我院1995年1月-2006年5月收治的31例妊娠合并甲减患者的临床资料,31例患者均在产科高危门诊定期保健,每1.0～1.5个月监测1次甲状腺功能,并与内分泌科合作调整患者的左旋甲状腺素剂量.对患者的围产期保健、药物治疗量及母婴结局进行回顾性分析.结果 (1)发病率:我院近11年来妊娠合并甲减的发病率为1.27‰(31/24 327)[0.19‰(1/5251)～2.32‰(15/6456)].(2)左旋甲状腺素用量:左旋甲状腺素的平均剂量孕前、孕早期、孕中期、孕晚期、产后分别为(33±35)、(51±36)、(68±42)、(76±42)、(38±34)μg/d,孕早期及产后与孕前比较,差异无统计学意义(P＞0.05);孕中期及孕晚期与孕前比较,左旋甲状腺素应用量明显增加,差异有统计学意义(P＜0.05),整个孕期的左旋甲状腺素平均用量比孕前增加约35%.(3)妊娠结局:31例患者中有5例妊娠期糖代谢异常,发生率为16%(5/31);1例胎儿六指畸形,1例新生儿窒息(Apgar评分1分钟7分,5分钟10分);31例患者中无一例围产儿死亡,无新生儿先天性甲减.结论 妊娠合并甲减发病率逐年升高.孕期需及时增加左旋甲状腺素用量,对改善妊娠合并甲减患者的妊娠结局具有良好的治疗作用.

Clinical analysis of hypothyroidism during pregnancy

OBJECTIVE: To investigate the incidence, treatment and pregnant outcomes of women with hypothyroidism during pregnancy. METHODS: A retrospective analysis was conducted on the perinatal care, treatment and pregnant outcomes of 31 pregnant women with hypothyroidism from Jan.1995 to May.2006 in our hospital. All subjects were received in the high risk clinic, and the thyroid function was monitored every 1.0 - 1.5 months. The dosage of LT4 was adjusted to maintain the normal level of thyroid function. RESULTS: The incidence of maternal hypothyroidism during the study period was 1.27 per thousand (31/24 327) [0.19 per thousand (1/5251) - 2.32 per thousand (15/6456)]. The average LT4 dosage in pre-gestation, the first, second, third trimester and postpartum was (33 +/- 35), (51 +/- 36), (68 +/- 42), (76 +/- 42) and (38 +/- 34) microg/d, respectively. Compared with the pre-gestational period, the dosage in the first trimester or postpartum was higher although the difference was not significant (P>0.05). The required dose of LT4 during the second and third trimester was respectively, remarkably increased compared to pre-gestational period (P<0.05). The average increase of the dose of LT4 required during the pregnancies was about 35%. All of 31 women had uneventful pregnancies. No perinatal mortality or congenital hypothyroidism occurred. The incidence of abnormal glucose metabolism was up to 16.1%. CONCLUSIONS: The incidence of maternal hypothyroidism is increasing yearly. It is of great value in improving the pregnant outcome through adjusting the LT4 dose during pregnancy and close monitoring of maternal and fetal status.