中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
Chinese Journal of Endocrinology and Metabolism
2015年
11期
937-940
,共4页
李春仙%陈敏%李美红%苏敏敏%励晶
李春仙%陳敏%李美紅%囌敏敏%勵晶
리춘선%진민%리미홍%소민민%려정
妊娠%亚临床甲状腺功能减退症%妊娠结局
妊娠%亞臨床甲狀腺功能減退癥%妊娠結跼
임신%아림상갑상선공능감퇴증%임신결국
Pregnancy%Subclinical hypothyroidism%Pregnant outcome
目的 评估妊娠妇女亚临床甲状腺功能减退症(SCH)对妊娠结局的影响及药物干预治疗后妊娠结局的改变情况.方法 选取1 786名早期妊娠妇女,于妊娠早、中、晚期测定其血清游离甲状腺素(FT4)、总甲状腺素(TT4)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体水平,对妊娠早期检出的123例SCH孕妇以随机数字表法随机分成治疗组(42例)和非治疗组(81例).治疗组参照美国甲状腺学会推荐的方案给予左旋甲状腺素(L-T4)治疗,复查甲状腺功能.追踪随访所有孕妇的妊娠结局及产科并发症发生情况,进行统计分析.结果 (1) SCH组与对照组比较:妊娠早期SCH妇女自发性流产发生率升高(20.99％对8.45％,x2=12.96,P=0.00);妊娠中期SCH妇女妊娠期糖尿病发生率升高(24.69％对10.45％,x2=14.11,P=0.00);而在妊娠期高血压、早产、胎盘早剥、前置胎盘、胎儿生长受限、出生低体重的发生率上差异均无统计学意义(均P＞0.05).(2)治疗组与非治疗组比较:自发性流产发生率(7.14％对20.99％,x2=3.89,P=0.05)、妊娠期糖尿病发生率(9.52％对24.69％,x2 =4.05,P=0.04)均下降,而在妊娠期高血压、早产、胎盘早剥、前置胎盘、胎儿生长受限、出生低体重的发生率上差异均无统计学意义(均P＞0.05).结论 妊娠早期SCH是自发性流产的危险因素;妊娠中期SCH是妊娠期糖尿病的危险因素;妊娠期SCH经L-T4干预治疗可使临床获益.
目的 評估妊娠婦女亞臨床甲狀腺功能減退癥(SCH)對妊娠結跼的影響及藥物榦預治療後妊娠結跼的改變情況.方法 選取1 786名早期妊娠婦女,于妊娠早、中、晚期測定其血清遊離甲狀腺素(FT4)、總甲狀腺素(TT4)、促甲狀腺激素(TSH)、甲狀腺過氧化物酶抗體水平,對妊娠早期檢齣的123例SCH孕婦以隨機數字錶法隨機分成治療組(42例)和非治療組(81例).治療組參照美國甲狀腺學會推薦的方案給予左鏇甲狀腺素(L-T4)治療,複查甲狀腺功能.追蹤隨訪所有孕婦的妊娠結跼及產科併髮癥髮生情況,進行統計分析.結果 (1) SCH組與對照組比較:妊娠早期SCH婦女自髮性流產髮生率升高(20.99％對8.45％,x2=12.96,P=0.00);妊娠中期SCH婦女妊娠期糖尿病髮生率升高(24.69％對10.45％,x2=14.11,P=0.00);而在妊娠期高血壓、早產、胎盤早剝、前置胎盤、胎兒生長受限、齣生低體重的髮生率上差異均無統計學意義(均P＞0.05).(2)治療組與非治療組比較:自髮性流產髮生率(7.14％對20.99％,x2=3.89,P=0.05)、妊娠期糖尿病髮生率(9.52％對24.69％,x2 =4.05,P=0.04)均下降,而在妊娠期高血壓、早產、胎盤早剝、前置胎盤、胎兒生長受限、齣生低體重的髮生率上差異均無統計學意義(均P＞0.05).結論 妊娠早期SCH是自髮性流產的危險因素;妊娠中期SCH是妊娠期糖尿病的危險因素;妊娠期SCH經L-T4榦預治療可使臨床穫益.
목적 평고임신부녀아림상갑상선공능감퇴증(SCH)대임신결국적영향급약물간예치료후임신결국적개변정황.방법 선취1 786명조기임신부녀,우임신조、중、만기측정기혈청유리갑상선소(FT4)、총갑상선소(TT4)、촉갑상선격소(TSH)、갑상선과양화물매항체수평,대임신조기검출적123례SCH잉부이수궤수자표법수궤분성치료조(42례)화비치료조(81례).치료조삼조미국갑상선학회추천적방안급여좌선갑상선소(L-T4)치료,복사갑상선공능.추종수방소유잉부적임신결국급산과병발증발생정황,진행통계분석.결과 (1) SCH조여대조조비교:임신조기SCH부녀자발성유산발생솔승고(20.99％대8.45％,x2=12.96,P=0.00);임신중기SCH부녀임신기당뇨병발생솔승고(24.69％대10.45％,x2=14.11,P=0.00);이재임신기고혈압、조산、태반조박、전치태반、태인생장수한、출생저체중적발생솔상차이균무통계학의의(균P＞0.05).(2)치료조여비치료조비교:자발성유산발생솔(7.14％대20.99％,x2=3.89,P=0.05)、임신기당뇨병발생솔(9.52％대24.69％,x2 =4.05,P=0.04)균하강,이재임신기고혈압、조산、태반조박、전치태반、태인생장수한、출생저체중적발생솔상차이균무통계학의의(균P＞0.05).결론 임신조기SCH시자발성유산적위험인소;임신중기SCH시임신기당뇨병적위험인소;임신기SCH경L-T4간예치료가사림상획익.
Objective To evaluate the impact of subclinical hypothyroidism (SCH) on the outcome of pregnancy and the therapeutic effect of L-T4.Methods A total of 1 786 pregnant women during the first, second, and third trimesters were enrolled for thyroid screening by determining serum free thyroxine (FT4), total thyroxine (TT4), thyrotropin (TSH), and thyroid peroxidase antibody;123 pregnant women with SCH were successfully divided into treated group (n =42) and untreated group (n =81).The treated group was treated by L-T4 based on American Thyroid Association (ATA) 2011 guideline.Collected items include obstetric outcomes and complications.Results (1) Compared to control group, the rate of spontaneous abortion in pregnant women during first trimesters was increased in SCH group (20.99％ vs 8.45％, x2 =12.96, P =0.00), with higher incidence of diabetes during second trimester (24.69％ vs 10.45％, x2 =14.11, P =0.00).The incidences of hypertension during pregnancy, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight showed no difference between two groups (all P ＞ 0.05).(2) Compared with the untreated group, the incidences of spontaneous abortion and diabetes were decreased in the treated group (7.14％ vs 20.99％, x2 =3.89, P =0.05;9.52％ vs 24.69％, x2 =4.05, P =0.04), while the incidences of hypertension, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight infant accident rate were not different between two groups (all P ＞ 0.05).Conclusions SCH during the frist trimester is a risk factor of spontaneous abortion;SCH during the middle stage of pregnancy is a risk factor of gestational diabetes mellitus.Treatment of SCH with L-T4 may be beneficial.
