妊娠期孕妇亚临床甲减对妊娠结局的影响

摘要

目的：探讨妊娠期孕妇合并亚临床甲减对妊娠结局的影响。方法选择2013年6月至2014年6月在我院产科产检及分娩的2280例妊娠妇女为研究对象，对其进行甲状腺功能筛查，对甲减患者均遵医嘱给予优甲乐(L-T4)替代治疗，其中以严格遵医嘱进行治疗的73例亚临床甲减孕妇为治疗组，未遵医嘱进行治疗的34例亚临床甲减孕妇为观察组，同期就诊的50例正常孕妇为对照组，观察三组孕妇的妊娠结局及终止妊娠时各组的甲状腺功能。结果经过筛查，2280例妊娠孕妇中甲减175例，发生率为7.68%，其中临床甲减68例，占38.86%，亚临床甲减107例，占61.14%。治疗后，对照组与治疗组比较，促甲状腺激素(TSH)、游离甲状腺素(FT4)水平差异均无统计学意义(P>0.05)；观察组TSH水平显著高于对照组和治疗组，FT4水平显著低于对照组和治疗组，差异均有统计学意义(P<0.05)；三组甲状腺过氧化物酶抗体(TPOAb)水平比较差异均有统计学意义(P<0.05)。观察组不良妊娠结局的发生率显著高于对照组和治疗组，差异有统计学意义(P<0.05)。结论妊娠期孕妇合并亚临床甲减可导致产妇妊娠并发症和围产儿不良结局的发生。对亚临床甲减孕妇的早期诊断和治疗，并进行严密监测，可减少母儿并发症的发生，从而改善不良妊娠结局的发生。%Objective To explore the effect of subclinical hypothyroidism on pregnancy outcome of preg-nant women. Methods A total of 2 280 pregnant women from 2013 June to 2014 June were selected as research ob-jects, which all received thyroid function screening. The patients with hypothyroidism were given euthyrox (L-T4) for replacement therapy. Seventy-three patients of subclinical hypothyroidism strictly prescribed for treatment were chosen as treatment group, 34 patients of subclinical hypothyroidism not strictly prescribed for treatment were en-rolled as the observation group, and 50 healthy pregnant women in the same period were selected as the control group. The pregnancy outcome of three groups and thyroid function at termination of pregnancy were observed. Results After screening, among the 2 280 pregnant women, 175 had hypothyroidism (with the incidence of 7.68%), including 68 cases of clinical hypothyroidism (38.86%) and 107 cases of subclinical hypothyroidism (61.14%). After treatment, the thyrotropin (TSH), free thyroxine (FT4) level in the control group and the treatment group had no statis-tically significant difference (P>0.05). The TSH level in the observation group was significantly higher than that of the treatment group and the control group, and the FT4 level was significantly lower than the control group and treatment group, with statistically significant difference (P<0.05). TPOAb level showed statistically significant difference be-tween the three groups (P<0.05). The incidence of adverse pregnancy outcome of the observation group was sig-nificantly higher than that in the control group and treatment group, and the difference was statistically significant (P<0.05). Conclusion The gestational thyroid function of early screening and treatment can effectively improve the thyroid function, carries on the strict monitoring of subclinical hypothyroidism in pregnant women, and reduce the ma-ternal and fetal complications, thus improve the occurrence of adverse pregnancy outcome.