李晏

【摘要】 目的：探討优甲乐（L-T4）治疗妊娠合并甲减或亚临床甲减患者期间治疗剂量的变化，为临床应用的替代剂量提供数据基础。方法：48例妊娠合并甲减或亚临床甲减患者为观察组，42例单胎妊娠无甲减或亚临床甲减志愿者为对照组，从妊娠前、妊娠早期30～90 d、中期150～180 d、后期240～270 d、及分娩后90 d内几个阶段L-T4的实际治疗剂量进行统计分析，化学发光免疫法测定不同妊娠阶段血清中TSH水平，并观察两组研究对象甲状腺家族史、妊娠期糖尿病、高血压合并症的发生情况，以及围生产期结局相关情况。结果：观察组妊娠前及分娩后TSH水平与对照组比较差异均无统计学意义（P>0.05），妊娠期（妊娠早期、中期及晚期）与对照组比较差异均有统计学意义（P<0.05）。观察组妊娠中、晚期与妊娠早期比较差异均有统计学意义（P<0.05）；与妊娠前相比，妊娠早、中、晚期L-T4需求剂量显著增加（P<0.05）；与妊娠早期相比，妊娠中、晚期L-T4剂量显著增加（P<0.05）。观察组甲状腺相关疾病家族史发生明显比对照组高，而观察组经过L-T4剂量调节的治疗在妊娠期间糖尿病发生及高血压的发生与对照组比较差异无统计学意义（P>0.05），在围生产期结局如早产发生情况、ICP发生率、贫血发生率、妊娠周数、出生儿体重方面与对照组比较差异均无统计学意义（P>0.05）。结论：甲减患者妊娠期间要在基础治疗剂量上随着妊娠期的增加逐步增加L-T4的用量，分娩后所需药量逐步下降，至3个月后恢复到妊娠前水平。

【关键词】 优甲乐； 妊娠合并甲减； 妊娠合并亚临床甲减； 治疗剂量； TSH

【Abstract】 Objective：To investigate hypothyroidism during the pregnant of woman with dosage changes of Euthyrox，then in order to provide data foundation for alternative dose of clinical application.Method：48 pregnant patients with hypothyroidism or subclinical hypothyroidism were chosen as the observation group， while 42 cases with pregnant alone were chosen as the control group，the dose of Euthyrox before pregnancy，early pregnancy 30-90 d，medium-term pregnancy 150-180 d， and late pregnancy 240-270 d and within 90 d after childbirth were recorded and analyzed statistically.The levels of TSH in serum were determined by CLIA （cheniluminescence immunoassay）.The two groups of patients with thyroid gland family history，gestational diabetes mellitus，hypertension complications， as well as perinatal outcomes were observed.Result：There was no significant statistic difference in the TSH level between before pregnancy and after delivery in the observation group compared with the control group（P>0.05），and the TSH level of the pregnancy （early pregnancy，middle and late pregnancy） had significant difference compared with the control group（P<0.05）.The TSH level of the observation group in the middle and late pregnancy had significant difference compared with early pregnancy（P<0.05）.Compared to the observation group before pregnancy，the dose of Euthyrox was significantly higher in the early，medium and late pregnancy（P<0.05）.Compared to the early pregnancy in observation，the dose of Euthyrox was significantly higher in the medium and late pregnancy（P<0.05）.The family history of thyroid related disease in the observation group was significantly higher than the control group.After the Euthyrox therapy of dose adjustment，the incidence of diabetes and hypertension in the observation group had no significant differences in pregnancy compared to the control group（P>0.05）.There were no significant differences in the perinatal outcomes such as preterm birth incidence，the incidence of ICP，the incidence of anemia，gestational weeks and birth weight between the observation group and the control group（P>0.05）.Conclusion：The required amount of Euthyrox is increased gradually in the patients of hypothyroidism during pregnancy while the required amount is declined after childbirth and recovers to the progestational level three months later.endprint

【Key words】 Euthyrox； Hypothyroidism during the pregnant； Subclinical hypothyroidism during the pregnant； Therapeutic dose； TSH

First-authors address：Maternal and Child Health Care Hospital of Nantong，Nantong 226000，China

doi：10.3969/j.issn.1674-4985.2017.31.008

甲状腺功能减退症（简称甲减），是由于甲状腺激素合成减少，生物效应不足或缺乏引起的甲状腺功能减退性疾病。甲减可导致人体发育迟缓，代谢异常，记忆力明显减退，妊娠合并甲减或亚临床甲减可影响胎儿神经系统发育从而影响智力发育。妊娠期甲状腺疾病已经成为内分泌领域及妇产科的一个研究热点，国外的流行病学研究结果显示，妊娠期亚临床甲状腺功能减退（简称亚临床甲减）的发生率为2.2%～2.3%，而我国的发生率更高为5.32%[1-3]。妊娠期的……