早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床研究
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摘要
目的探讨早期综合干预联合左甲状腺素钠治疗妊娠合并甲状腺功能减退症的临床效果及其对生化指标的影响。方法将2012年1月至2016年12月遵化市人民医院收治的194例妊娠合并甲状腺功能减退症病人按随机数字表法分为研究组(97例)和对照组(97例),对照组病人给予早期综合干预治疗,研究组病人给予早期综合干预联合左甲状腺素钠治疗。观察两组病人治疗后分娩结局(妊娠终止、自然分娩、阴道助产、剖宫产)、母婴结局(产后出血、宫缩乏力、胎儿窘迫及新生儿窒息)以及预后效果,同时检测治疗前后相关生化指标[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺刺激激素(TSH)、人绒毛膜促性腺激素(hC G)和脂联素(ADPN)]和社会支持评定量表(SSRS)评分变化。结果联合治疗后研究组病人妊娠终止率(5. 15%比22. 68%)、剖宫产率(6. 19%比26. 80%)、产后出血率(10. 31%比35. 05%)、宫缩乏力率(9. 28%比36. 08%)、胎儿窘迫率(11. 34%比34. 02%)及新生儿窒息率(10. 31%比31. 96%)低于治疗后的对照组(χ2值依次=12. 43、14. 97、16. 93、19. 87、14. 23、13. 64,均P <0. 001),自然分娩率68 (70. 10%)、总有效率93 (95. 88%)高于治疗后的对照组[30(30. 93%)、71(73. 20%)](均P <0. 05),而治疗后两组病人阴道助产率比较差异无统计学意义(P> 0. 05);治疗后两组病人生化指标(FT3、FT4、hC G和ADPN)和SSRS评分高于治疗前,而TSH低于治疗前(P <0. 05);与治疗后对照组相比,治疗后研究组病人生化指标(FT3、FT4、hC G和ADPN)和SSRS评分升高,而TSH降低(P <0. 05)。结论早期综合干预联合左甲状腺素钠可有效改善妊娠合并甲状腺功能减退症病人分娩结局、母婴结局、生化指标以及预后。
Objective To observe the clinical effection of early comprehensive intervention combined with levothyroxine sodium in thetreatment of hypothyroidism of pregnancy and the generated effects on biochemical indexes. Methods A sample of 194 pregnant women affected with hypothyroidism in the People's Hospital of Zunhua were selected and randomly divided in to two groups: the research group and the control group. The control group were treated with early comprehensive intervention while the research group were treated with early comprehensive intervention combined with levothyroxine sodium. The delivery results(Termination of pregnancy,spontaneous delivery,vaginal delivery,cesarean section),mother-infant outcomes(Postpartum hemorrhage,atony of uterus,fetal distress and asphyxia of the newborn),and prognosis were observed,and the biochemical indexes [free triiodinated thyroiine 3(FT3),free triiodinated thyroiine 4(FT4),thyrotropin stimulating hormone(TSH),human chorionic gonadotropin(hC G) and adiponectin(ADPN) ] and Social Support Rating Scale(SSRS) score were examined to compare the difference between the two therapies. Results After treatment,termination rate of pregnancy(5. 15% vs. 22. 68%),cesarean section rate(6. 19% vs. 26. 80%),postpartum hemorrhage(10. 31% vs. 35. 05%),atony of uterus(9. 28% vs. 36. 08%),and fetal distress(11. 34% vs. 34. 02%) and asphyxia of the newborn(10. 31% vs. 31. 96%) in the research group was significantly lower than that in the control group(χ2= 12. 43,14. 97,16. 93,19. 87,14. 23,13. 64,P < 0. 001),the rate of natural childbirth,total efficiency,and excellent rate in the research group was significantly higher than that in the control group(P < 0. 05). However,there was no significant difference in vaginal delivery between the two groups(P > 0. 05). Compared with before treatment,biochemical indexes [Free triiodothyronine 3(FT3),Free thyroxine(FT4),Human chorionic gonadotropin(hC G),and Adiponectin(ADPN) ] and SSRS score in two groups after treatment significant increased but thyroid stimulating hormone(TSH) significant decreased(P < 0. 05). Compared with the control group after treatment,biochemical indexes(FT3,FT4,hC G,and ADPN) and SSRS score in the research groups after treatment significant increased but TSH significant decreased(P < 0. 05). Conclusion Early comprehensive intervention combined with levothyroxine effectively improves outcomes of labor,outcomes of mother and baby,biochemical indexes,and prognosis in pregnancy with hypothyroidism.
Objective To observe the clinical effection of early comprehensive intervention combined with levothyroxine sodium in thetreatment of hypothyroidism of pregnancy and the generated effects on biochemical indexes. Methods A sample of 194 pregnant women affected with hypothyroidism in the People's Hospital of Zunhua were selected and randomly divided in to two groups: the research group and the control group. The control group were treated with early comprehensive intervention while the research group were treated with early comprehensive intervention combined with levothyroxine sodium. The delivery results(Termination of pregnancy,spontaneous delivery,vaginal delivery,cesarean section),mother-infant outcomes(Postpartum hemorrhage,atony of uterus,fetal distress and asphyxia of the newborn),and prognosis were observed,and the biochemical indexes [free triiodinated thyroiine 3(FT3),free triiodinated thyroiine 4(FT4),thyrotropin stimulating hormone(TSH),human chorionic gonadotropin(hC G) and adiponectin(ADPN) ] and Social Support Rating Scale(SSRS) score were examined to compare the difference between the two therapies. Results After treatment,termination rate of pregnancy(5. 15% vs. 22. 68%),cesarean section rate(6. 19% vs. 26. 80%),postpartum hemorrhage(10. 31% vs. 35. 05%),atony of uterus(9. 28% vs. 36. 08%),and fetal distress(11. 34% vs. 34. 02%) and asphyxia of the newborn(10. 31% vs. 31. 96%) in the research group was significantly lower than that in the control group(χ2= 12. 43,14. 97,16. 93,19. 87,14. 23,13. 64,P < 0. 001),the rate of natural childbirth,total efficiency,and excellent rate in the research group was significantly higher than that in the control group(P < 0. 05). However,there was no significant difference in vaginal delivery between the two groups(P > 0. 05). Compared with before treatment,biochemical indexes [Free triiodothyronine 3(FT3),Free thyroxine(FT4),Human chorionic gonadotropin(hC G),and Adiponectin(ADPN) ] and SSRS score in two groups after treatment significant increased but thyroid stimulating hormone(TSH) significant decreased(P < 0. 05). Compared with the control group after treatment,biochemical indexes(FT3,FT4,hC G,and ADPN) and SSRS score in the research groups after treatment significant increased but TSH significant decreased(P < 0. 05). Conclusion Early comprehensive intervention combined with levothyroxine effectively improves outcomes of labor,outcomes of mother and baby,biochemical indexes,and prognosis in pregnancy with hypothyroidism.
引文
[1]HOFER-INTEEWORN N,PANCIERA DL,MONROE WE,et al.Effect of hypothyroidism on insulin sensitivity and glucose tolerance in dogs[J].Am J Vet Res,2012,73(4):529-538.
[2]CHAKER L,BAUMGARTNER C,DEN ELZEN WP,et al.Subclinical hypothyroidism and the risk of stroke events and fatal stroke:an individual participant data analysis[J].J Clin Endocr Metab,2015,100(6):2181-2191.
[3]ZHANG M,SARA JD,MATSUZAWA Y,et al.Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention[J].Eur Heart J,2016,37(26):2055-2065.
[4]PADIOLLEAU S.Augmenter le taux de gestation en repérant le pic de LH[J].Energ Fuel,2015,21(1):163-170.
[5]刘思诗,刘彩霞.妊娠期临床甲状腺功能减退症的诊断标准及危害和处理[J].实用妇产科杂志,2015,31(12):888-890.
[6]SMAJDOR J,PIECH R,RUMIN M,et al.High Sensitive Voltammetric Levothyroxine Sodium Determination on Renewable Mercury Film Silver Based Electrode[J].J Electrochem Soc,2016,163(7):H605-H609.
[7]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南(节选一)[J].中华全科医师杂志,2012,11(8):556-558.
[8]陈肖肖,施玉华,曹丽佩,等.左旋甲状腺素钠治疗先天性甲状腺功能减退症的初始剂量研究[J].中华内分泌代谢杂志,2010,26(4):273-277.
[9]CHAN S,BOELAERT K.Optimal management of hypothyroidism,hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy[J].Clin Endocrinol(Oxf),2015,82(3):313-326.
[10]HENNESSEY JV,ESPAILLAT R.Subclinical hypothyroidism:a historical view and shifting prevalence[J].Int J Clin Pract,2015,69(7):771-782.
[11]LGER J.Congenital hypothyroidism:a clinical update of longterm outcome in young adults[J].Eur J Endocrinol,2015,172(2):R67-77.
[12]OKOSIEME O,GILBERT J,ABRAHAM P,et al.Management of primary hypothyroidism:statement by the British Thyroid Association Executive Committee[J].Clin Endocrinol(Oxf),2016,84(6):799-808.
[13]ZHANG Y,FAN Y,YU X,et al.Maternal subclinical hypothyroidism impairs neurodevelopment in rat offspring by inhibiting the CREB signaling pathway[J].Mol Neurobiol,2015,52(1):432-441.
[14]孙晨,马建,赵娜.姜桂益瘿汤治疗脾肾阳虚型桥本氏甲状腺功能减退症的临床观察[J].天津中医药大学学报,2016,35(1):15-18.
[15]孙亚玲,辛春,郭明,等.早期综合干预联合左甲状腺素钠用于妊娠合并甲状腺功能减退的疗效观察[J].临床合理用药杂志,2016,9(7):60-61.
[16]孙亚玲,辛春,郭明,等.早期综合干预结合左甲状腺素钠治疗妊娠合并甲状腺功能减退对母婴结局及预后的影响[J].临床合理用药杂志,2016,9(1):100-101.
[17]BONE HG,WALTER MA,HURLEY ME,et al.Pharmacokinetics of coadministration of levothyroxine sodium and alendronate sodium new effervescent formulation[J].Osteoporosis Int,2017,28(5):1745-1752.
[18]HAMADA Y,MASUDA K,OKUBO M,et al.Pharmaceutical studies of levothyroxine sodium hydrate suppository provided as a hospital preparation[J].Biol Pharm Bull,2015,38(4):625-628.
[19]ESCOBAR-MORREALE HF,BOTELLA-CARRETERO JI,DE ES-COBAR G M.Treatment of hypothyroidism with levothyroxine or a combination of levothyroxine plus L-triiodothyronine[J].Best Pract Res Clin Endocrinol Metab,2015,29(1):57-75.
[20]杨咏梅,金安林.左甲状腺素钠片在老年甲状腺功能减退症治疗中的临床应用[J].广西医科大学学报,2016,33(2):341-343.
[2]CHAKER L,BAUMGARTNER C,DEN ELZEN WP,et al.Subclinical hypothyroidism and the risk of stroke events and fatal stroke:an individual participant data analysis[J].J Clin Endocr Metab,2015,100(6):2181-2191.
[3]ZHANG M,SARA JD,MATSUZAWA Y,et al.Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention[J].Eur Heart J,2016,37(26):2055-2065.
[4]PADIOLLEAU S.Augmenter le taux de gestation en repérant le pic de LH[J].Energ Fuel,2015,21(1):163-170.
[5]刘思诗,刘彩霞.妊娠期临床甲状腺功能减退症的诊断标准及危害和处理[J].实用妇产科杂志,2015,31(12):888-890.
[6]SMAJDOR J,PIECH R,RUMIN M,et al.High Sensitive Voltammetric Levothyroxine Sodium Determination on Renewable Mercury Film Silver Based Electrode[J].J Electrochem Soc,2016,163(7):H605-H609.
[7]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南(节选一)[J].中华全科医师杂志,2012,11(8):556-558.
[8]陈肖肖,施玉华,曹丽佩,等.左旋甲状腺素钠治疗先天性甲状腺功能减退症的初始剂量研究[J].中华内分泌代谢杂志,2010,26(4):273-277.
[9]CHAN S,BOELAERT K.Optimal management of hypothyroidism,hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy[J].Clin Endocrinol(Oxf),2015,82(3):313-326.
[10]HENNESSEY JV,ESPAILLAT R.Subclinical hypothyroidism:a historical view and shifting prevalence[J].Int J Clin Pract,2015,69(7):771-782.
[11]LGER J.Congenital hypothyroidism:a clinical update of longterm outcome in young adults[J].Eur J Endocrinol,2015,172(2):R67-77.
[12]OKOSIEME O,GILBERT J,ABRAHAM P,et al.Management of primary hypothyroidism:statement by the British Thyroid Association Executive Committee[J].Clin Endocrinol(Oxf),2016,84(6):799-808.
[13]ZHANG Y,FAN Y,YU X,et al.Maternal subclinical hypothyroidism impairs neurodevelopment in rat offspring by inhibiting the CREB signaling pathway[J].Mol Neurobiol,2015,52(1):432-441.
[14]孙晨,马建,赵娜.姜桂益瘿汤治疗脾肾阳虚型桥本氏甲状腺功能减退症的临床观察[J].天津中医药大学学报,2016,35(1):15-18.
[15]孙亚玲,辛春,郭明,等.早期综合干预联合左甲状腺素钠用于妊娠合并甲状腺功能减退的疗效观察[J].临床合理用药杂志,2016,9(7):60-61.
[16]孙亚玲,辛春,郭明,等.早期综合干预结合左甲状腺素钠治疗妊娠合并甲状腺功能减退对母婴结局及预后的影响[J].临床合理用药杂志,2016,9(1):100-101.
[17]BONE HG,WALTER MA,HURLEY ME,et al.Pharmacokinetics of coadministration of levothyroxine sodium and alendronate sodium new effervescent formulation[J].Osteoporosis Int,2017,28(5):1745-1752.
[18]HAMADA Y,MASUDA K,OKUBO M,et al.Pharmaceutical studies of levothyroxine sodium hydrate suppository provided as a hospital preparation[J].Biol Pharm Bull,2015,38(4):625-628.
[19]ESCOBAR-MORREALE HF,BOTELLA-CARRETERO JI,DE ES-COBAR G M.Treatment of hypothyroidism with levothyroxine or a combination of levothyroxine plus L-triiodothyronine[J].Best Pract Res Clin Endocrinol Metab,2015,29(1):57-75.
[20]杨咏梅,金安林.左甲状腺素钠片在老年甲状腺功能减退症治疗中的临床应用[J].广西医科大学学报,2016,33(2):341-343.
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