蒋达玲

摘 要：目的 研究左甲狀腺素钠片治疗妊娠期甲状腺功能减退症的临床效果。方法 选取2014年1月～2017年12月在我院就诊的妊娠期甲状腺功能减退症患者80例，随机分为观察组和对照组，每组40例。对照组常规使用甲状腺素片治疗，观察组采用左甲状腺素钠片治疗，对比两组患者治疗前后TSH、FT3、FT4的变化，治疗后妊娠并发症（妊高症、产后出血、贫血、流产、早产）情况，以及围产儿不良结局（胎儿宫内窘迫、胎儿畸形、死胎、低体质量）发生率情况。结果 观察组治疗后TSH、FT3、FT4的改善均优于对照组，差异具有统计学意义（P<0.05）。观察组妊高症、产后出血、贫血、早产发生率低于对照组，差异具有统计学意义（P<0.05）；观察组治疗后妊娠并发症总发生率为15.00%，低于对照组的55.00%，差异具有统计学意义（P<0.05）。观察组胎儿宫内窘迫、低体质量发生率低于对照组，差异具有统计学意义（P<0.05）；观察组围产儿不良结局总发生率为5.00%，低于对照组的27.50%，差异具有统计学意义（P<0.05）。结论 采用左甲状腺素钠片治疗妊娠期甲状腺功能减退症，可改善血清TSH、FT3、FT4指标，降低妊娠并发症和围产儿不良结局发生率，有利于改善妊娠结局。

关键词：左甲状腺素钠片；妊娠期；甲状腺功能减退症；并发症

中图分类号：R714.256 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.042

文章编号：1006-1959（2018）20-0139-03

Abstract：Objective To study the clinical effect of levothyroxine sodium tablets in the treatment of hypothyroidism during pregnancy. Methods 80 patients with hypothyroidism during pregnancy from January 2014 to December 2017 were randomly divided into observation group and control group，with 40 cases in each group.The control group was treated with thyroxine tablets.The observation group was treated with levothyroxine sodium tablets.The changes of TSH，FT3 and FT4 before and after treatment were compared between the two groups.Pregnancy complications（pregnancy-induced hypertension，postpartum hemorrhage，anemia，abortion，premature birth conditions）as well as the incidence of perinatal adverse outcomes（fetal distress，fetal malformation，stillbirth，low body mass）. Results The improvement of TSH，FT3 and FT4 in the observation group was better than that in the control group，the difference was statistically significant（P<0.05）.The incidence of pregnancy-induced hypertension，postpartum hemorrhage，anemia，and premature delivery in the observation group was lower than that in the control group，the difference was statistically significant（P<0.05）.The total incidence of pregnancy complications in the observation group was 15.00%，55.00% lower than the control group，the difference was statistically significant（P<0.05）.The incidence of intrauterine distress and low body mass in the observation group was lower than that in the control group，the difference was statistically significant（P<0.05）.The total incidence of adverse outcomes in perinatal infants in the observation group was 5.00%，which was lower than that in the control group 27.50%，the difference was statistically significant（P< 0.05）.Conclusion The use of levothyroxine sodium tablets in the treatment of hypothyroidism during pregnancy can improve serum TSH，FT3，FT4 indicators，reduce the incidence of pregnancy complications and perinatal adverse outcomes，and help to improve pregnancy outcomes.

Key words：Levothyroxine sodium tablets；Pregnancy；Hypothyroidism；Complications

甲状腺功能减退症（hypothyroidism）是临床常见的内分泌疾病，其发病的高危人群为育龄期妇女。妊娠期妇女由于胎盘大量分泌激素，一直处于应激状态，导致免疫状态随之改变，从而对甲状腺激素的产生和代谢具有一定的影响。甲状腺功能减退是一种低代谢综合征，主要临床表现为乏力、眼睑水肿、突然怕冷等[1]。虽然甲状腺功能减退症的症状较轻，但是对妊娠结局可造成不利影响。妊娠期甲状腺功能减退症可能导致胎儿神经智力系统的发育异常，增加流产、早产的机率，提高妊娠期高血压疾病、低体重儿及死胎的发生风险。本研究选取了2014年1月～2017年12月在我院就诊的妊娠期甲状腺功能减退症患者80例，通过对比治疗着重分析左甲状腺素钠片对该疾病的改善效用，现报道如下。……