CAJ | 학술논문

目的探讨左旋甲状腺素治疗对亚临床甲状腺功能减退症( SCH)孕妇血清叶酸和甲状腺功能的影响. 方法选取妊娠中晚期孕妇及体检中心常规体检的育龄妇女95例,分为妊娠期SCH组( A组,30例)、妊娠期甲状腺功能正常组( B组,35例)及育龄期甲状腺功能正常组( C组,30例) ,妊娠期SCH组患者接受左旋甲状腺素治疗,妊娠期SCH患者在治疗前及治疗8周后,其他受试者在治疗前空腹采静脉血,检测叶酸、促甲状腺激素、游离甲状腺激素( FT4 )、游离三碘甲状腺原氨酸( FT3 )、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇( HDL-C)、低密度脂蛋白-胆固醇( LDL-C). 结果 A组血清叶酸水平显著低于B、C组( P<0.01 ). A组总胆固醇,水平亦显著高于B、C组( P<0.01 ).孕妇血清促甲状腺激素与叶酸水平存在弱的负相关( r=-0.20 ,P>0.05 ) ,与总胆固醇、LDL-C水平呈正相关(均P<0.05). 治疗后,A组患者叶酸显著升高,血清促甲状腺激素显著降低(均P<0.05) ,而FT3 ,FT4 水平无明显变化(均P>0.05). 结论叶酸水平降低和高总胆固醇、LDL-C 水平可能是SCH孕妇发生不良妊娠结局的危险因素. 左旋甲状腺素治疗能升高SCH孕妇的血清叶酸水平,降低血清促甲状腺激素水平,对改善妊娠结局可能有积极意义.
목적 탐토좌선갑상선소치료대아림상갑상선공능감퇴증( SCH)잉부혈청협산화갑상선공능적영향. 방법 선취임신중만기잉부급체검중심상규체검적육령부녀95례,분위임신기SCH조( A조,30례)、임신기갑상선공능정상조( B조,35례)급육령기갑상선공능정상조( C조,30례) ,임신기SCH조환자접수좌선갑상선소치료,임신기SCH환자재치료전급치료8주후,기타수시자재치료전공복채정맥혈,검측협산、촉갑상선격소、유리갑상선격소( FT4 )、유리삼전갑상선원안산( FT3 )、공복혈당、총담고순、삼선감유、고밀도지단백담고순( HDL-C)、저밀도지단백-담고순( LDL-C). 결과 A조혈청협산수평현저저우B、C조( P<0.01 ). A조총담고순,수평역현저고우B、C조( P<0.01 ).잉부혈청촉갑상선격소여협산수평존재약적부상관( r=-0.20 ,P>0.05 ) ,여총담고순、LDL-C수평정정상관(균P<0.05). 치료후,A조환자협산현저승고,혈청촉갑상선격소현저강저(균P<0.05) ,이FT3 ,FT4 수평무명현변화(균P>0.05). 결론 협산수평강저화고총담고순、LDL-C 수평가능시SCH잉부발생불량임신결국적위험인소. 좌선갑상선소치료능승고SCH잉부적혈청협산수평,강저혈청촉갑상선격소수평,대개선임신결국가능유적겁의의.
Objective To investigate the effect of levothyroxine on the serum concentration of folate acids and thyroid function in pregnant women with subclinical hypothyroidism .Methods A total of 95 subjects including 65 pregnant women during the second and third trimesters and 30 controls were involved in this study .The participants were divided into three groups based on the thyroid function:30 pregnant women with subclinical hypothyroidism ( A group ) , 35 pregnant women with normal thyroid function ( B group ) and 30 fertile women with normal thyroid function ( C group ) .The patients in A group were treatment with levothy-roxine.The levels of folate, thyroid stimulating hormone , free thyroxine ( FT4 ) , free triiodothyronine ( FT3 ) , fasting plasma glucose , total choles-terol, triglyceride,high density lipoprotein -cholesterol(HDL-C), low density lipoprotein-cholesterol(LDL-C) were detected before and after treatment.Results Serum folate concentration in the A group were sig-nificantly lower than that in the B group and C group (P<0.01).Levels of total cholesterol and LDL -C in the A group were significantly higher than those in the B group and C group ( P<0.01 ) .The level of thyroid-stimulating hormone has a mild inverse correlation with the level of folate concentra-tion( r=-0.20 , P>0.05 ) , but has a positive correlation with total cholesterol and LDL -C levels ( r=0.21 and 0.29 , P<0.05 ,respectively ) in pregnant women .In A group patients , folate concentration significantly increased , but the level of thyroid -stimulating hormone level significantly decreased after treatment ( both P<0.05 ) .The changes of free triiodothyronine or free thyroid hormone level was not significantly ( both P>0.05 ) .Conclusion Lower folate concentration , higher total cholesterol and LDL -C levels may be considered as risk factors of bad pregnancy outcomes in pregnant women with subclinical hypothyroidism .Treatment with levothyroxine can significantly increase serum folate and reduce thyroid-stimulating hormone , which might have a positive meaning for improving pregnancy outcome .