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
좌선갑상선소치료임신기아림상갑감부녀대후대신경지력발육영향적전첨성연구
Levothyroxine treatment for subclinical hypothyroidism during pregnancy and the subsequent neuropsychological development of the offspring: a prospective epidemiological study
  • 万方数据
    中华内分泌代谢杂志 중화내분비대사잡지
    CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
    2010年 11期 921-925 ,共5页

    于晓会%王薇薇%滕卫平%单忠艳%李佳%李元宾%陈彦彦%李静%薛海波%范晨玲%王红%张红梅%郭锐%李晨阳%周卫卫%高波%尚涛%周佳任%丁彬%马英%武英%徐晖%刘伟

    우효회%왕미미%등위평%단충염%리가%리원빈%진언언%리정%설해파%범신령%왕홍%장홍매%곽예%리신양%주위위%고파%상도%주가임%정빈%마영%무영%서휘%류위

    妊娠%亚临床甲状腺功能减退%左旋甲状腺素%前瞻性研究 妊娠%亞臨床甲狀腺功能減退%左鏇甲狀腺素%前瞻性研究
    임신%아림상갑상선공능감퇴%좌선갑상선소%전첨성연구
    Pregnancy%Subclinical hypothyroidism%Levothyroxine%Prospective study
    目的 通过前瞻性观察妊娠期亚临床甲状腺功能减退(甲减)妇女左旋甲状腺素(L-T4)治疗后甲状腺功能指标的动态变化和后代神经智力的发育情况,探讨L-T4对妊娠期亚临床甲减妇女后代神经智力发育的影响.方法17例亚临床甲减孕妇未接受治疗(SCH组),23例亚临床甲减孕妇接受L-T4治疗(SCH+LT4组),24例正常孕妇(C组)作为对照组.3组孕妇分别在妊娠12周(G12)、16周(G16)、20周(G20)、24周(G24)、28周(G28)、32周(G32)和(或)36周(G36)接受随访检查,检测血清TSH、TT4、FT4、TT3、FT3、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb).应用Bayley量表对所有孕妇的后代在14～30月龄检测智力和运动评分.结果SCH组、SCH+LT4组和C组孕妇后代的智力发育指数(MDI)分别为115.12分、118.56分和117.63分;运动发育指数(PDI)分别为115.47分、120.65分和117.50分.与其他两组比较,SCH+LT4组MDI和PDI评分均较高,SCH组MDI和PDI评分均较低,但3组间比较没有统计学差异.SCH组孕妇的血清TSH在妊娠过程中始终保持在2.0 mIU/L以上,各时点都明显高于C组(均P＜0.05);血清TT4和FT4水平除G28和G32外其他时点均略低于同时点C组水平.SCH+LT4组孕妇基础血清TSH水平明显高于其他两组(均P＜0.01),血清TT4和FT4水平则低于其他两组;在接受L-T4治疗后血清TSH水平明显下降,自G12至孕末期始终与C组水平相当,且低于同时点SCH组孕妇的水平;血清TT4和FT4水平则明显升高至与对照组相当的水平.结论L-T4的及时治疗能够维持妊娠早期亚临床甲减患者妊娠全程血清TSH在正常水平,这很可能会避免后代智力和运动能力发育水平的下降.
    목적 통과전첨성관찰임신기아림상갑상선공능감퇴(갑감)부녀좌선갑상선소(L-T4)치료후갑상선공능지표적동태변화화후대신경지력적발육정황,탐토L-T4대임신기아림상갑감부녀후대신경지력발육적영향.방법17례아림상갑감잉부미접수치료(SCH조),23례아림상갑감잉부접수L-T4치료(SCH+LT4조),24례정상잉부(C조)작위대조조.3조잉부분별재임신12주(G12)、16주(G16)、20주(G20)、24주(G24)、28주(G28)、32주(G32)화(혹)36주(G36)접수수방검사,검측혈청TSH、TT4、FT4、TT3、FT3、갑상선과양화물매항체(TPOAb)화갑상선구단백항체(TgAb).응용Bayley량표대소유잉부적후대재14～30월령검측지력화운동평분.결과SCH조、SCH+LT4조화C조잉부후대적지력발육지수(MDI)분별위115.12분、118.56분화117.63분;운동발육지수(PDI)분별위115.47분、120.65분화117.50분.여기타량조비교,SCH+LT4조MDI화PDI평분균교고,SCH조MDI화PDI평분균교저,단3조간비교몰유통계학차이.SCH조잉부적혈청TSH재임신과정중시종보지재2.0 mIU/L이상,각시점도명현고우C조(균P＜0.05);혈청TT4화FT4수평제G28화G32외기타시점균략저우동시점C조수평.SCH+LT4조잉부기출혈청TSH수평명현고우기타량조(균P＜0.01),혈청TT4화FT4수평칙저우기타량조;재접수L-T4치료후혈청TSH수평명현하강,자G12지잉말기시종여C조수평상당,차저우동시점SCH조잉부적수평;혈청TT4화FT4수평칙명현승고지여대조조상당적수평.결론L-T4적급시치료능구유지임신조기아림상갑감환자임신전정혈청TSH재정상수평,저흔가능회피면후대지력화운동능력발육수평적하강.
    Objective To prospectively observe the effect of levothyroxine treatment on neuropsychological development in offspring of pregnant women with subclinical hypothyroidism. Methods Twenty-three pregnant women with subclinical hypothyroidism received levothyroxine therapy (SCH+LT4 group) and 17 who did not receive levothyroxine ( SCH group) were enrolled; 24 pregnant women with normal thyroid function were referred as controls (C group). All the subjects underwent the planned thyroid tests regularly. Serum TSH, TT4, FT4, TT3,FT3, TPOAb, and TgAb levels were determined. Their 14-30 month-old children underwent the tests relating to intelligence and motor activity with the Bayley scale. Results In SCH group, SCH+LT4 group, and C group, the MDI were 115. 12, 118.56, and 117.63, respectively. And the PDI were 115.47, 120.65, and 117.50,respectively. The MDI and PDI were the highest in SCH+LT4 group and were the lowest in SCH group. Serum TSH levels remained above 2.0 mIU/L during the whole course of pregnancy in SCH group and higher than that in C group at all time points ( P＜0.05 ). Serum TT4 and FT4 levels were lower in SCH group than in C group at all time points except G28 and G32. The baseline TSH level in SCH+LT4 group was the highest ( P＜0.01 ), their TT4 and FT4 levels were the lowest among the three groups. In SCH + LT4 group, serum TSH, TT4, and FT4 levels were similar to C group after L-T4 treatment. Conclusion The prompt L-T4 treatment can maintain normal TSH levels in pregnant women with subclinical hypothyroidism during the whole course of pregnancy, and impairment of neuropsychological development in infants may be avoided.
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