L-T4替代治疗对妊娠期亚临床甲状腺功能减退孕妇血清抵抗素、同型半胱氨酸的影响
|
摘要
目的探讨左旋甲状腺激素替代治疗(L-T4)对妊娠期亚临床甲状腺功能减退(SCH)孕妇血清抵抗素(RE)、同型半胱氨酸(HCY)的影响。方法选取2014年1月-2016年1月该院收治的90例SCH患者,依据随机数字表法将其分为两组:观察组接受L-T4替代治疗,每隔4周复查甲状腺激素(TSH)水平,治疗目标为妊娠早期TSH水平在0.3~2.5 mIU/L,中期和晚期为0.3~3.0 mIU/L,直到治疗达标为止;对照组不接受治疗,每隔4周复查TSH水平。所有患者入院次日及复查TSH当日取空腹肘静脉血,测定血清HCY和RE水平,记录妊娠结局和子代发育12个月的智力情况。结果观察组治疗8周后,血清TSH达到0.3~3.0 m IU/L,达到治疗目标,故将治疗8周的时间点定义为治疗后。观察组治疗后,血清TSH、HCY水平降低(P <0.05),游离甲状腺素(FT4)、RE水平升高(P <0.05),对照组各指标无变化(P>0.05);观察组治疗后的TSH较对照组低(P <0.05),FT4指标较对照组高(P <0.05);观察组不良妊娠结局发生率(10.3%)低于对照组(28.1%)(P <0.05);两组子代发育12个月时的精细动作发育商(FMQ)、大运动发育商(GMQ)、个人社交发育商(ISBQ)及语言发育商(LQ)评分比较,差异均有统计学意义(P <0.05)。结论妊娠早期行左旋甲状腺激素替代治疗有助于降低SCH患者血清TSH、HCY水平,升高抵抗素水平,改善母体状态和妊娠结局,并促进子代智力发育,具有一定的临床意义。
Objective To evaluate application of L-thyroid hormone(L-T4) replacement therapy inpregnant women with subclinical hypothyroidism(SCH). Methods Totally 90 cases of SCH admitted in our hospital from January 2014 to January 2017 were enrolled and randomly divided into the observation group in which patients were treated with L-T4, and control group in which no treatment was employed. The goal of TSH level 0.3-3.0 mIU/L. TSH, serum HCY and RE were checked every 4 weeks. Pregnancy outcome and intelligence development at 12 nd month were recorded. Results Serum levels of TSH and HCY levels in observation group were decreased(P < 0.05)and FT4 and RE levels were increased(P < 0.05) significantly post treatment when compared with the same patient prior to any treatments or control group. However no obvious changes were observed in control group. Patients in observation group experienced decreased rate of adverse outcome when compared with control group(P < 0.05). Significant differences of FMQ, GMQ, ISBQ and LQ in two groups were witnessed(P < 0.05). Conclusion L-thyroid hormone replacement therapy is of promising clinical significance.
Objective To evaluate application of L-thyroid hormone(L-T4) replacement therapy inpregnant women with subclinical hypothyroidism(SCH). Methods Totally 90 cases of SCH admitted in our hospital from January 2014 to January 2017 were enrolled and randomly divided into the observation group in which patients were treated with L-T4, and control group in which no treatment was employed. The goal of TSH level 0.3-3.0 mIU/L. TSH, serum HCY and RE were checked every 4 weeks. Pregnancy outcome and intelligence development at 12 nd month were recorded. Results Serum levels of TSH and HCY levels in observation group were decreased(P < 0.05)and FT4 and RE levels were increased(P < 0.05) significantly post treatment when compared with the same patient prior to any treatments or control group. However no obvious changes were observed in control group. Patients in observation group experienced decreased rate of adverse outcome when compared with control group(P < 0.05). Significant differences of FMQ, GMQ, ISBQ and LQ in two groups were witnessed(P < 0.05). Conclusion L-thyroid hormone replacement therapy is of promising clinical significance.
引文
[1]CASEY B M,THOM E A,PEACEMAN A M,et al.Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy[J].New England Journal of Medicine,2017,376(9):815-825.
[2]孙亚琴.左甲状腺素钠联合中药治疗SCH伴血脂异常的临床观察[J].世界中西医结合杂志,2016,18(5):707-709.
[3]胡庆芬,邓宁,邱宇阳.L-T4对妊娠期亚临床甲状腺功能减退妇女后代神经智力发育的影响研究[J].中国医药导刊,2016,15(1):48-49.
[4]YANG N,YAO Z,MIAO L,et al.Novel clinical evidence of an association between homocysteine and insulin resistance in patients with hypothyroidism or subclinical hypothyroidism[J].PLoS One,2015,10(5):1-10.
[5]AKSOY D Y,CINAR N,HARMANCI A,et al.Serum resistin and high sensitive CRP levels in patients with subclinical hypothyroidism before and after L-thyroxine therapy[J].Medical Science Monitor,2013,19(8):210-215.
[6]沈莺,李梅芳,李连喜.美国甲状腺协会2011年妊娠期及产后甲状腺疾病诊治指南解读[J].世界临床药物,2011,32(10):634-639.
[7]郑建霞,何亚萍,乔国昱.唐山地区2012~2014年孕早期亚临床甲状腺功能减退的调查分析[J].标记免疫分析与临床,2016,23(5):522-524.
[8]李建宁,赵迎春,何岚,等.妊娠期亚临床甲状腺功能减退症对其后代智力的影响及干预效果分析[J].中国医科大学学报,2015,44(1):64-67.
[9]郝迎春.妊娠亚临床甲状腺功能减退症的危害与治疗[J].中国社区医师:医学专业,2013,15(2):50-50.
[10]胡庆芬,邓宁,邱宇阳.L-T4对妊娠期亚临床甲状腺功能减退妇女后代神经智力发育的影响研究[J].中国医药导刊,2016,18(1):48-49.
[11]MOOG N K,ENTRINGER S,HEIM C,et al.Influence of maternal thyroid hormones during gestation on fetal brain development[J].Neuroscience,2017,342(13):68-100.
[12]ZHIHONG L,RUIYING W.妊娠甲状腺功能亢进症对子代脑发育的影响[J].临床荟萃,2016,31(3):258-261.
[13]汪启迪,陈名道,唐金凤,等.不同甲状腺功能状态对人体血清瘦素水平的影响[J].中华内分泌代谢杂志,2001,17(2):96-99.
[14]代丽丽,耿玉兰,孙静娜,等.超敏C反应蛋白和抵抗素与亚临床甲状腺功能减退症的相关性[J].广东医学,2014,35(12):1911-1912.
[15]李鲁宏,蔡佩雅,张培茹,等.妊娠期亚临床甲状腺功能减退症患者血清叶酸,维生素B12,同型半胱氨酸水平测定及临床意义[J].中外医学研究,2016,14(11):55-57.
[2]孙亚琴.左甲状腺素钠联合中药治疗SCH伴血脂异常的临床观察[J].世界中西医结合杂志,2016,18(5):707-709.
[3]胡庆芬,邓宁,邱宇阳.L-T4对妊娠期亚临床甲状腺功能减退妇女后代神经智力发育的影响研究[J].中国医药导刊,2016,15(1):48-49.
[4]YANG N,YAO Z,MIAO L,et al.Novel clinical evidence of an association between homocysteine and insulin resistance in patients with hypothyroidism or subclinical hypothyroidism[J].PLoS One,2015,10(5):1-10.
[5]AKSOY D Y,CINAR N,HARMANCI A,et al.Serum resistin and high sensitive CRP levels in patients with subclinical hypothyroidism before and after L-thyroxine therapy[J].Medical Science Monitor,2013,19(8):210-215.
[6]沈莺,李梅芳,李连喜.美国甲状腺协会2011年妊娠期及产后甲状腺疾病诊治指南解读[J].世界临床药物,2011,32(10):634-639.
[7]郑建霞,何亚萍,乔国昱.唐山地区2012~2014年孕早期亚临床甲状腺功能减退的调查分析[J].标记免疫分析与临床,2016,23(5):522-524.
[8]李建宁,赵迎春,何岚,等.妊娠期亚临床甲状腺功能减退症对其后代智力的影响及干预效果分析[J].中国医科大学学报,2015,44(1):64-67.
[9]郝迎春.妊娠亚临床甲状腺功能减退症的危害与治疗[J].中国社区医师:医学专业,2013,15(2):50-50.
[10]胡庆芬,邓宁,邱宇阳.L-T4对妊娠期亚临床甲状腺功能减退妇女后代神经智力发育的影响研究[J].中国医药导刊,2016,18(1):48-49.
[11]MOOG N K,ENTRINGER S,HEIM C,et al.Influence of maternal thyroid hormones during gestation on fetal brain development[J].Neuroscience,2017,342(13):68-100.
[12]ZHIHONG L,RUIYING W.妊娠甲状腺功能亢进症对子代脑发育的影响[J].临床荟萃,2016,31(3):258-261.
[13]汪启迪,陈名道,唐金凤,等.不同甲状腺功能状态对人体血清瘦素水平的影响[J].中华内分泌代谢杂志,2001,17(2):96-99.
[14]代丽丽,耿玉兰,孙静娜,等.超敏C反应蛋白和抵抗素与亚临床甲状腺功能减退症的相关性[J].广东医学,2014,35(12):1911-1912.
[15]李鲁宏,蔡佩雅,张培茹,等.妊娠期亚临床甲状腺功能减退症患者血清叶酸,维生素B12,同型半胱氨酸水平测定及临床意义[J].中外医学研究,2016,14(11):55-57.