L—T4替代疗法在亚临床甲状腺功能减退孕妇中的研究(1)
[摘要] 目的 了解采用甲状腺素替代疗法对妊娠期甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)阴性的亚临床甲状腺功能减退症孕妇的临床转归。 方法 回顾分析宁波市妇女儿童医院妊娠甲状腺病门诊就诊患者的资料，确诊妊娠合并亚临床甲状腺功能减退症且甲状腺自身抗体(TPOAb/TgAb)阴性，按照是否接受甲状腺素替代治疗分为治疗组(A组)与对照组(B组)，治疗组60例，对照组60例，选取同期正常妊娠孕妇60例作为C组，分析三组的妊娠结局。 结果 对于TPOAb和TgAb阴性亚临床甲减孕妇，A组早产、延期妊娠、子痫前期等妊娠并发症发生率明显低于B组(P<0.05)。 结论 对妊娠妇女早期进行甲状腺功能筛查，及时发现亚临床甲减孕妇，当甲状腺自身抗体阴性时也推荐应用甲状腺素早期干预，可以降低临床不良事件的发生。
[关键词] 左旋甲状腺素片；甲状腺过氧化物酶抗体；亚临床甲状腺功能减退症；补充治疗
[中图分类号] R714.256 [文献标识码] B [文章编号] 1673-9701(2017)08-0102-04
[Abstract] Objective To investigate the clinical outcome of thyroid hormone replacement therapy in pregnant women with subclinical hypothyroidism thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) negative during pregnancy. Methods The data of patients admitted at thyroid disease clinic in our hospital were retrospective analyzed， and pregnancy with subclinical hypothyroidism and negative thyroid autoantibody(TPOAb/TgAb) was diagnosed. According to whether or not to receive thyroxine replacement therapy， the patients were divided into treatment group (group A， n=60) and control group(group B， n=60). 60 cases of pregnant women with normal pregnancy in the same period were selected as group C. And the pregnancy outcome of the three groups was analyzed. Results For pregnant patients with TPOAb and TgAb negative subclinical hypothyroidism， the incidence in adverse events including premature birth， expired pregnancy， preeclampsia of group A were significantly lower than those of the group B(P<0.05). Conclusion Thyroid function in pregnant women is screened in the early stage to detect subclinical hypothyroidism promptly. And the application of thyroid hormone for early intervention is also recommended when thyroid autoantibody is negtive，which can reduce the incidence of clinical adverse events.
[Key words] L-thyroxine tablets； Thyroid peroxidase antibody； Subclinical hypothyroidism； Supplemental therapy
早在1999年，Haddow等前瞻性研究提出亚临床甲状腺功能减退(subclinical hypothyroidism，SCH) 可影响胎儿神经系统的发育，并且造成后代智力水平降低。这种对亚临床甲状腺功能减退的认识，引起国际内分泌学界、尤其是优生优育学界的高度关注[1]。亚临床甲状腺功能减退是指血清促甲状腺激素(TSH)增高，而血清游离甲状腺素(FT4)在正常参考范围内。已有研究显示妊娠合并甲状腺自身抗体阳性的亚临床甲减可引起多种不良妊娠结局，如先兆流产、流产、先兆子痫、胎儿宫内生长受限、胎儿畸形以及胎儿神经智力发育缺陷，因此2011年，美国甲状腺协会发布指南，指出在妊娠期和产后甲状腺疾病的诊断和治疗中应对这部分孕妇进行甲状腺素片的激素替代治疗。2012年国内也发布指南做了同樣推荐[2]。但对于妊娠合并抗体阴性的亚临床甲状腺功能减退患者的治疗却没有提出明确意见。本研究拟通过分析妊娠妇女在早孕期间进行甲状腺功能筛查的流行病学数据，筛选出诊断为妊娠合并甲状腺自身抗体即甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)阴性的亚临床甲状腺功能减退孕妇120例，对其中60例进行左旋甲状腺素片(L-T4)干预治疗，通过分析临床结局探讨激素干预治疗的效果。
1 资料与方法, 百拇医药(林静 涂荣祖 徐丘卡)
[关键词] 左旋甲状腺素片；甲状腺过氧化物酶抗体；亚临床甲状腺功能减退症；补充治疗
[中图分类号] R714.256 [文献标识码] B [文章编号] 1673-9701(2017)08-0102-04
[Abstract] Objective To investigate the clinical outcome of thyroid hormone replacement therapy in pregnant women with subclinical hypothyroidism thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) negative during pregnancy. Methods The data of patients admitted at thyroid disease clinic in our hospital were retrospective analyzed， and pregnancy with subclinical hypothyroidism and negative thyroid autoantibody(TPOAb/TgAb) was diagnosed. According to whether or not to receive thyroxine replacement therapy， the patients were divided into treatment group (group A， n=60) and control group(group B， n=60). 60 cases of pregnant women with normal pregnancy in the same period were selected as group C. And the pregnancy outcome of the three groups was analyzed. Results For pregnant patients with TPOAb and TgAb negative subclinical hypothyroidism， the incidence in adverse events including premature birth， expired pregnancy， preeclampsia of group A were significantly lower than those of the group B(P<0.05). Conclusion Thyroid function in pregnant women is screened in the early stage to detect subclinical hypothyroidism promptly. And the application of thyroid hormone for early intervention is also recommended when thyroid autoantibody is negtive，which can reduce the incidence of clinical adverse events.
[Key words] L-thyroxine tablets； Thyroid peroxidase antibody； Subclinical hypothyroidism； Supplemental therapy
早在1999年，Haddow等前瞻性研究提出亚临床甲状腺功能减退(subclinical hypothyroidism，SCH) 可影响胎儿神经系统的发育，并且造成后代智力水平降低。这种对亚临床甲状腺功能减退的认识，引起国际内分泌学界、尤其是优生优育学界的高度关注[1]。亚临床甲状腺功能减退是指血清促甲状腺激素(TSH)增高，而血清游离甲状腺素(FT4)在正常参考范围内。已有研究显示妊娠合并甲状腺自身抗体阳性的亚临床甲减可引起多种不良妊娠结局，如先兆流产、流产、先兆子痫、胎儿宫内生长受限、胎儿畸形以及胎儿神经智力发育缺陷，因此2011年，美国甲状腺协会发布指南，指出在妊娠期和产后甲状腺疾病的诊断和治疗中应对这部分孕妇进行甲状腺素片的激素替代治疗。2012年国内也发布指南做了同樣推荐[2]。但对于妊娠合并抗体阴性的亚临床甲状腺功能减退患者的治疗却没有提出明确意见。本研究拟通过分析妊娠妇女在早孕期间进行甲状腺功能筛查的流行病学数据，筛选出诊断为妊娠合并甲状腺自身抗体即甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)阴性的亚临床甲状腺功能减退孕妇120例，对其中60例进行左旋甲状腺素片(L-T4)干预治疗，通过分析临床结局探讨激素干预治疗的效果。
1 资料与方法, 百拇医药(林静 涂荣祖 徐丘卡)