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

Application of L-thyroid hormone replacement therapy in pregnant women with sub clinical hypothyroidism

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 mIU/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。

Abstract:

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 12nd 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.