亚临床性甲状腺功能减退症对妊娠结局的影响及甲状腺激素替代疗法的疗效
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摘要
目的探讨亚临床性甲状腺功能减退症(subclinical hypothyroidism,SCH)对妊娠结局的影响及甲状腺激素替代疗法的临床疗效。方法选取2015年1月至2018年12月解放军总医院第五医学中心收治的216例SCH孕妇为研究对象,按照治疗方案将其分为高剂量组(高剂量左旋甲状腺素替代治疗,108例)和低剂量组(低剂量左旋甲状腺素替代治疗,108例),随机选取该院同期108例健康孕妇纳入健康组,比较三组孕妇不良妊娠结局、新生儿情况及新生儿甲状腺功能。结果高剂量组和健康组孕妇的流产率、早产率及新生儿血清促甲状腺激素(thyroid-stimulating hormone,TSH)水平均显著低于低剂量组(P_均<0.05)。三组新生儿低出生体重率、新生儿畸形率、Apgar评分、血清游离三碘甲腺原氨酸和游离甲状腺素水平均无显著差异(P_均> 0.05)。结论 SCH可增加孕妇流产、早产等不良妊娠结局的发生风险,并对新生儿TSH水平产生影响。甲状腺激素替代治疗可有效改善SCH孕妇的妊娠结局,临床可加强孕妇早期TSH筛查并给予药物干预措施,保障母婴健康。
Objective To investigate the effect of subclinical hypothyroidism(SCH) on pregnancy outcome and curative effect of thyroid hormone replacement therapy. Method A total of 216 pregnant women with SCH admitted to Fifth Medical Center, Chinese PLA General Hospital from January 2015 to December 2018 were selected as the subjects of the study. According to the treatment plan, they were divided into high dose group(high dose Levothyroxine replacement therapy, 108 cases) and low dose group(low dose Levothyroxine replacement therapy, 108 cases). 108 healthy pregnant women in that hospital were randomly included in health group during the same period. The adverse pregnancy outcomes, neonatal conditions and neonatal thyroid function among the three groups were compared. Result The abortion rate and premature delivery rate of pregnant women and neonatal serum thyroid-stimulating hormone(TSH) level in high dose group and healthy group were signi?cantly lower than those in low dose group(P_(all)< 0.05). There were no signi?cant differences in low birth weight rate, neonatal deformity rate, Apgar score, serum free triiodothyronine and free thyroxine levels among the three groups(P_(all)> 0.05). Conclusion SCH can increase the risk of abortion, premature delivery and other adverse pregnancy outcomes, and have an impact on neonatal TSH levels. Thyroid hormone replacement therapy can effectively improve the pregnancy outcome of SCH pregnant women, we can strengthen early TSH screening and drug intervention measures to ensure maternal and infant health.
Objective To investigate the effect of subclinical hypothyroidism(SCH) on pregnancy outcome and curative effect of thyroid hormone replacement therapy. Method A total of 216 pregnant women with SCH admitted to Fifth Medical Center, Chinese PLA General Hospital from January 2015 to December 2018 were selected as the subjects of the study. According to the treatment plan, they were divided into high dose group(high dose Levothyroxine replacement therapy, 108 cases) and low dose group(low dose Levothyroxine replacement therapy, 108 cases). 108 healthy pregnant women in that hospital were randomly included in health group during the same period. The adverse pregnancy outcomes, neonatal conditions and neonatal thyroid function among the three groups were compared. Result The abortion rate and premature delivery rate of pregnant women and neonatal serum thyroid-stimulating hormone(TSH) level in high dose group and healthy group were signi?cantly lower than those in low dose group(P_(all)< 0.05). There were no signi?cant differences in low birth weight rate, neonatal deformity rate, Apgar score, serum free triiodothyronine and free thyroxine levels among the three groups(P_(all)> 0.05). Conclusion SCH can increase the risk of abortion, premature delivery and other adverse pregnancy outcomes, and have an impact on neonatal TSH levels. Thyroid hormone replacement therapy can effectively improve the pregnancy outcome of SCH pregnant women, we can strengthen early TSH screening and drug intervention measures to ensure maternal and infant health.
引文
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[7]吴跃跃,陈琳,黄新梅,等.妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J].中华内分泌代谢杂志,2017,33(3):198-202.
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[12]王国成,麻伟博,孙红敏,等.妊娠期甲状腺疾病及其相关诊断指标的参考值范围研究现状[J].中华妇幼临床医学杂志(电子版),2017,13(5):503-510.
[13]Chen S,Zhou X,Zhu H,et al.Preconception TSH and pregnancy outcomes:a population‐based cohort study in 184 611women[J].Clin Endocrinol(Oxf),2017,86(6):816-824.
[14]刘玉芳,张晓梅,柴三葆,等.妊娠期亚临床甲状腺功能减退症对妊娠结局和后代的影响[J].中华内分泌代谢杂志,2017,33(3):269-272.
[15]Negro R,Schwartz A,Gismondi R,et al.Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy[J].J Clin Endocrinol Metab,2010,95(9):E44-E48.
[16]王婉萍,陈光盛.左旋甲状腺激素对妊娠伴亚临床甲状腺功能减退症患者妊娠结局、新生儿及甲状腺功能的影响[J].中国地方病防治杂志,2016,31(4):418-420.
[17]Alexander EK,Pearce EN,Brent GA,et al.2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum[J].Thyroid,2017,27(3):315-389.
[18]朱俊芹,于海伦.不同初始剂量左旋甲状腺素片治疗妊娠期亚临床甲状腺功能减退症临床效果观察[J].山东医药,2015,55(36):103-104.
[19]於丽红,苏胜偶,田素斋,等.妊娠亚临床甲状腺功能减退症干预模式的研究进展[J].现代预防医学,2015,42(22):4102-4104.
[2]陈媛媛,韩姹,薛凤霞.妊娠期低甲状腺素血症对子代认知及运动功能影响的研究进展[J].中华妇产科杂志,2018,53(5):344-347.
[3]李春睿,徐书杭,刘超.2014年欧洲甲状腺学会关于孕妇与儿童亚临床甲状腺功能减退指南的解读[J].中华内分泌代谢杂志,2015,31(3):201-204.
[4]张静,蔺莉.妊娠期亚临床甲状腺功能减退的诊治进展[J].中国妇产科临床杂志,2017,18(4):93-96.
[5]Dong AC,Stagnaro-Green A.Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy:A Systematic Review and Meta-Analysis[J].Thyroid,2019,29(2):278-289.
[6]Ma L,Qi H,Chai X,et al.The effects of screening and intervention of subclinical hypothyroidism on pregnancy outcomes:a prospective multicenter single-blind,randomized,controlled study of thyroid function screening test during pregnancy[J].JMatern Fetal Neonatal Med,2016,29(9):1391-1394.
[7]吴跃跃,陈琳,黄新梅,等.妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J].中华内分泌代谢杂志,2017,33(3):198-202.
[8]Maraka S,Singh Ospina NM,O'Keeffe DT,et al.Effects of Levo thyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism[J].Thyroid,2016,26(7):980-986.
[9]陆新妹,王志坚,邵婕.左旋甲状腺素治疗妊娠期亚临床甲状腺功能减退症疗效分析[J].中国计划生育和妇产科,2016,8(7):26-29.
[10]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):354-371.
[11]Yibing Z,Haoyu W,Xifeng P,et al.Patients with subclinical hypo thyroidism before 20 weeks of pregnancy have a higher risk of miscarriage:A systematic review and meta-analysis[J].PLoS One,2017,12(4):e0175708.
[12]王国成,麻伟博,孙红敏,等.妊娠期甲状腺疾病及其相关诊断指标的参考值范围研究现状[J].中华妇幼临床医学杂志(电子版),2017,13(5):503-510.
[13]Chen S,Zhou X,Zhu H,et al.Preconception TSH and pregnancy outcomes:a population‐based cohort study in 184 611women[J].Clin Endocrinol(Oxf),2017,86(6):816-824.
[14]刘玉芳,张晓梅,柴三葆,等.妊娠期亚临床甲状腺功能减退症对妊娠结局和后代的影响[J].中华内分泌代谢杂志,2017,33(3):269-272.
[15]Negro R,Schwartz A,Gismondi R,et al.Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy[J].J Clin Endocrinol Metab,2010,95(9):E44-E48.
[16]王婉萍,陈光盛.左旋甲状腺激素对妊娠伴亚临床甲状腺功能减退症患者妊娠结局、新生儿及甲状腺功能的影响[J].中国地方病防治杂志,2016,31(4):418-420.
[17]Alexander EK,Pearce EN,Brent GA,et al.2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum[J].Thyroid,2017,27(3):315-389.
[18]朱俊芹,于海伦.不同初始剂量左旋甲状腺素片治疗妊娠期亚临床甲状腺功能减退症临床效果观察[J].山东医药,2015,55(36):103-104.
[19]於丽红,苏胜偶,田素斋,等.妊娠亚临床甲状腺功能减退症干预模式的研究进展[J].现代预防医学,2015,42(22):4102-4104.