补肾养血安胎汤联合左甲状腺素钠片治疗妊娠伴甲状腺功能减退临床研究
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摘要
目的:探究补肾养血安胎汤联合左甲状腺素钠片对妊娠期合并甲状腺功能减退患者的影响。方法:选取妊娠期合并有甲状腺功能减退的患者94例,按随机数字表法分为治疗组和对照组各47例。对照组采用左甲状腺素钠片治疗,治疗组在对照组基础上加用补肾养血安胎汤治疗。观察并比较2组患者疗效,治疗前后2组患者妊娠期血脂指标水平、甲状腺功能指标水平和妊娠激素水平,妊娠期并发症的发生情况。结果:治疗前,2组游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、促甲状腺激素(TSH)水平比较,差异无统计学意义(P> 0.05)。治疗后,2组FT3、FT4水平较治疗前升高,TSH水平较治疗前降低;且治疗组FT3、FT4水平高于对照组,TSH水平低于对照组;差异均有统计学意义(P <0.05)。治疗前,2组人绒毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E_2)水平比较,差异无统计学意义(P> 0.05)。治疗后,2组HCG、P、E2较治疗前升高,且治疗组高于对照组,差异均有统计学意义(P <0.05)。治疗前,2组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P> 0.05)。治疗后,治疗组TC、TG和LDL-C水平较治疗前显著降低,且低于对照组(P <0.05),HDL-C水平较治疗前显著提高,且明显高于对照组(P <0.05);对照组TG、LDL-C较治疗前降低(P <0.05)。治疗组总有效率为89.36%,显著高于对照组的68.09%,差异有统计学意义(P <0.05)。结论:补肾养血安胎汤联合左甲状腺激素钠片能有效改善妊娠期合并甲状腺功能减退患者的甲状腺功能、降低血脂水平、改善妊娠激素水平,治疗效果满意且安全有效,值得临床推广使用。
Objective: To observe the clinical effect of Bushen Yangxue Antai tang combined with levothyroxine sodium tablets for patients with hypothyroidism during pregnancy. Methods: A total of 94 patients with hypothyroidism during pregnancy were selected and divided into the treatment group and the control group according to the random number table method,47 cases in each group. The control group was treated with levothyroxine sodium tablets,and the treatment group was treated with Bushen Yangxue Antai tang based on the treatment of the control group. The therapeutic effect,the levels of blood lipid, thyroid function and hormones during pregnancy and the incidence of pregnancy complications in the two groups were observed and compared before and after treatment. Results: Before treatment, there was no statistically significant differences in the comparison of levels of free triiodothyronine(FT3), free thyroxine(FT4) and thyroid-stimulating hormone(TSH) between the two groups(P > 0.05). After treatment, the levels of FT3 and FT4 in the two groups were increased when compared with those before treatment,and the levels of TSH were decreased; the levels of FT3 and FT4 in the treatment group were higher than those in the control group, and the level of TSH was lower than that in the control group,differences being significant(P < 0.05). Before treatment,there was no significant difference in the comparison of the levels of human chorionic gonadotropin(HCG), progesterone(P) and estradiol(E_2) between the two groups(P > 0.05). After treatment,levels of HCG,P and E_2 in the two groups were increased when compared with those before treatment,and the above levels in the treatment group were higher than those in the control group, differences being significant(P < 0.05).Before treatment, there was no significant difference in the comparison of the levels of total cholesterol(TC), triglyceride(TG),low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C) between the two groups(P > 0.05). After treatment,levels of TC,TG and LDL-C in the treatment group were significantly decreased when compared with those before treatment,and lower than those in the control group(P < 0.05);HDL-C level in the treatment group was significantly increased when compared with that before treatment,and was significantly higher than that in the control group(P < 0.05). In the control group,levels of TG and LDL-C were decreased when compared with those before treatment(P <0.05). The total effective rate in the treatment group was 89.36%, significantly higher than that of 68.09% in the control group, the difference being significant(P < 0.05). Conclusion: The therapy of Bushen Yangxue Antai tang combined with levothyroxine sodium tablets,can effectively improve the thyroid function of patients with hypothyroidism during pregnancy,reduce the level of blood lipid and improve the level of pregnancy hormones. The treatment effect is satisfactory,safe and effective, which is worthy of clinical promotion and use.
Objective: To observe the clinical effect of Bushen Yangxue Antai tang combined with levothyroxine sodium tablets for patients with hypothyroidism during pregnancy. Methods: A total of 94 patients with hypothyroidism during pregnancy were selected and divided into the treatment group and the control group according to the random number table method,47 cases in each group. The control group was treated with levothyroxine sodium tablets,and the treatment group was treated with Bushen Yangxue Antai tang based on the treatment of the control group. The therapeutic effect,the levels of blood lipid, thyroid function and hormones during pregnancy and the incidence of pregnancy complications in the two groups were observed and compared before and after treatment. Results: Before treatment, there was no statistically significant differences in the comparison of levels of free triiodothyronine(FT3), free thyroxine(FT4) and thyroid-stimulating hormone(TSH) between the two groups(P > 0.05). After treatment, the levels of FT3 and FT4 in the two groups were increased when compared with those before treatment,and the levels of TSH were decreased; the levels of FT3 and FT4 in the treatment group were higher than those in the control group, and the level of TSH was lower than that in the control group,differences being significant(P < 0.05). Before treatment,there was no significant difference in the comparison of the levels of human chorionic gonadotropin(HCG), progesterone(P) and estradiol(E_2) between the two groups(P > 0.05). After treatment,levels of HCG,P and E_2 in the two groups were increased when compared with those before treatment,and the above levels in the treatment group were higher than those in the control group, differences being significant(P < 0.05).Before treatment, there was no significant difference in the comparison of the levels of total cholesterol(TC), triglyceride(TG),low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C) between the two groups(P > 0.05). After treatment,levels of TC,TG and LDL-C in the treatment group were significantly decreased when compared with those before treatment,and lower than those in the control group(P < 0.05);HDL-C level in the treatment group was significantly increased when compared with that before treatment,and was significantly higher than that in the control group(P < 0.05). In the control group,levels of TG and LDL-C were decreased when compared with those before treatment(P <0.05). The total effective rate in the treatment group was 89.36%, significantly higher than that of 68.09% in the control group, the difference being significant(P < 0.05). Conclusion: The therapy of Bushen Yangxue Antai tang combined with levothyroxine sodium tablets,can effectively improve the thyroid function of patients with hypothyroidism during pregnancy,reduce the level of blood lipid and improve the level of pregnancy hormones. The treatment effect is satisfactory,safe and effective, which is worthy of clinical promotion and use.
引文
[1]李进,张丽梅,于宁.妊娠期亚临床甲减对妊娠结局及围产儿的影响及甲状腺激素替代治疗效果观察[J].中国计划生育学杂志,2019,27(1):91-94.
[2]张洁芳,李远,曹彦敏,等.左甲状腺素钠对妊娠早期甲状腺过氧化物酶抗体阴性的亚临床甲状腺功能减退患者围产结局的影响[J].临床荟萃,2016,31(3):293-295.
[3]许园姣,吴志军,赖育美.妊娠伴发甲状腺功能减退的妊娠结局分析[J].中国医药科学,2016,8(2):81-83.
[4]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[J].中华内分泌代谢杂志,2012,28(5):354-367.
[5]刘伟靓,田金.左甲状腺素钠片对妊娠伴甲状腺功能减退患者脂代谢及妊娠期并发症的影响[J].中国实用医刊,2018,45(16):64-67.
[6]单忠艳.妊娠期甲状腺功能减退症的诊治进展[J].天津医药,2016,44(11):1297-1301.
[7]胡欣欣,孙云,马大正,等.移植后应用补胞汤及着床后应用温肾安胎对体外受精-胚胎移植妊娠结局的研究[J].浙江中医药大学学报,2014,38(8):970-972,975.
[8]王立媛,陈颖.妊娠合并甲状腺功能减退72例临床分析[J].山东医药,2013,53(36):68-70.
[9]尹鑫,刘文,梁登辉,等.自拟健脾补肾养血安胎汤联合左甲状腺素钠片治疗孕早期先兆流产合并亚临床甲状腺功能减退症疗效观察[J].现代中西医结合杂志,2017,26(17):1900-1902.
[10]于晓会,王薇薇,滕卫平,等.左旋甲状腺素治疗妊娠期亚临床甲减妇女对后代神经智力发育影响的前瞻性研究[J].中华内分泌代谢杂志,2010,26(11):921-925.
[2]张洁芳,李远,曹彦敏,等.左甲状腺素钠对妊娠早期甲状腺过氧化物酶抗体阴性的亚临床甲状腺功能减退患者围产结局的影响[J].临床荟萃,2016,31(3):293-295.
[3]许园姣,吴志军,赖育美.妊娠伴发甲状腺功能减退的妊娠结局分析[J].中国医药科学,2016,8(2):81-83.
[4]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[J].中华内分泌代谢杂志,2012,28(5):354-367.
[5]刘伟靓,田金.左甲状腺素钠片对妊娠伴甲状腺功能减退患者脂代谢及妊娠期并发症的影响[J].中国实用医刊,2018,45(16):64-67.
[6]单忠艳.妊娠期甲状腺功能减退症的诊治进展[J].天津医药,2016,44(11):1297-1301.
[7]胡欣欣,孙云,马大正,等.移植后应用补胞汤及着床后应用温肾安胎对体外受精-胚胎移植妊娠结局的研究[J].浙江中医药大学学报,2014,38(8):970-972,975.
[8]王立媛,陈颖.妊娠合并甲状腺功能减退72例临床分析[J].山东医药,2013,53(36):68-70.
[9]尹鑫,刘文,梁登辉,等.自拟健脾补肾养血安胎汤联合左甲状腺素钠片治疗孕早期先兆流产合并亚临床甲状腺功能减退症疗效观察[J].现代中西医结合杂志,2017,26(17):1900-1902.
[10]于晓会,王薇薇,滕卫平,等.左旋甲状腺素治疗妊娠期亚临床甲减妇女对后代神经智力发育影响的前瞻性研究[J].中华内分泌代谢杂志,2010,26(11):921-925.