李刚 王渝琦 范玉兰

[摘要] 目的 研究妊娠晚期新发甲状腺功能减退患者应用左甲状腺素钠片治疗的效果及对新生儿出生质量的影响。方法 方便选取2016年1月—2018年1月来该院诊治的妊娠晚期新发甲状腺功能减退患者500例作为研究对象，按照随机数字表达法分为研究组（n=250）和对照组（n=250），研究组应用左甲状腺素钠片治疗妊娠晚期新发甲状腺功能减退患者，对照组不接受左甲状腺素钠片治疗，对比两组患者的治疗效果，包括治疗前后甲状腺功能以及母婴情况。结果 研究组患者治疗后TSH水平较之治疗前和对照组显著降低（P<0.05）;不良妊娠发生率，研究组为15.2%，对照组为94.4%，研究组显著低于对照组（χ2=4.870，P<0.05）;围产儿并发症发生率，研究组为15.2%，对照组为97.2%，研究组显著低于对照组（χ2=5.010，P<0.05）。结论 左甲状腺素钠片对妊娠晚期新发甲状腺功能减退患者的治疗效果好，能够提高患者甲状腺功能，安全性高，改善不良妊娠，新生儿出生质量高，值得进一步应用和推广。

[关键词] 妊娠晚期;新发甲状腺功能减退;左甲状腺素钠片;新生儿出生质量;治疗效果

[Abstract] Objective To study the effect of levothyroxine sodium tablets on neonatal hypothyroidism in late pregnancy and its effect on newborn birth quality. Methods A total of 500 patients with newly diagnosed hypothyroidism in late pregnancy who came to the hospital from January 2016 to January 2018 were conveniently selected as the research subjects. They were divided into a study group （n=250） and a control group （n=250）. The study group used levothyroxine sodium tablets to treat patients with newly diagnosed hypothyroidism in late pregnancy. The control group did not receive levothyroxine sodium tablets. The treatment effects of the two groups were compared， including the thyroid function before and after treatment， and the situation of the mother and child. Results The levels of TSH in the study group after treatment were significantly lower than those before treatment and in the control group （P<0.05）. The incidence of adverse pregnancy was 15.2% in the study group and 94.4% in the control group. The study group was significantly lower than the control group （χ2=4.870， P<0.05）; The incidence of perinatal complications was 15.2% in the study group and 97.2% in the control group. The study group was significantly lower than the control group（χ2=5.010， P<0.05）. Conclusion Levothyroxine sodium tablets are effective in the treatment of patients with newly-onset hypothyroidism in the third trimester of pregnancy， which can improve patients' thyroid function， have high safety， improve adverse pregnancy， and have high birth quality for newborns， which deserves further application and promotion.

[Key words] Late pregnancy; New hypothyroidism; Levothyroxine sodium tablets; Neonatal birth quality; Treatment effect

妊娠晚期新發甲状腺功能减退是指妊娠早期筛查甲状腺功能正常，妊娠晚期筛查发现甲状腺功能减退，发病率极高，如果妊娠晚期者不能得到及时治疗，就易增加患者妊娠期间发生不良事件的几率，从而使母婴的生命健康情况得到严重威胁[1-3]。

以往认为妊娠期甲状腺功能减退并不常见，但近年来妊娠甲减趋于常见，其中妊娠晚期更易被忽视，甲状腺功能减退症状无特异性而且不典型，如产生体重增加、便秘、浮肿等现象[4]。以上几种症状一般为孕期正常生理现象，所以甲减常被掩盖。甲减严重危害心血管系统、生殖系统，在妊娠期间易产生高血压、糖尿病、早产、流产、死胎，也会对胎儿神经系统发育造成影响[5]。对妊娠期甲减进行筛查具有重要意义，特别是妊娠晚期甲状腺功能筛查，要检测妊娠期女性血清TSH、FT3、FT4水平[6]。……