孙璞 芮广海 金锋

【摘要】 目的 探讨妊娠期治疗甲状腺功能低下（甲减）对母婴预后的影响。方法 98例甲减孕妇， 随机分为对照组和观察组， 每组49例。对照组仅给予饮食、运动等健康指导， 观察组在此基础上给予左甲状腺素钠治疗。比较两组治疗后甲状腺激素水平、分娩方式、母婴结局、新生儿各指标。

结果 治疗后， 观察组血清游离三碘甲状腺原氨酸（FT3）、血清游离甲状腺素（FT4）水平高于对照组， 促甲状腺激素（TSH）低于对照组， 差异具有统计学意义（P<0.05）。观察组自然分娩率67.35%明显高于对照组的42.86%， 剖宫产率20.41%明显低于对照组的38.78%， 差异具有统计学意义（P<0.05）;两组自然流产率、阴道助产率比较差异无统计学意义（P>0.05）。觀察组母体、胎儿/新生儿并发症发生率分别为12.24%、10.20%， 明显低于对照组的28.57%、26.53%， 差异具有统计学意义（P<0.05）。观察组新生儿出生胎龄、出生体重、出生Apgar评分均优于对照组， 差异具有统计学意义（P<0.05）。结论 妊娠期治疗甲减能有效改善甲状腺激素水平， 提高自然分娩率， 降低母婴并发症发生率， 提高新生儿出生质量， 减少不良妊娠结局的发生， 具有积极的临床意义。

【关键词】 甲状腺功能低下;妊娠期;左甲状腺素钠;母婴预后

DOI：10.14163/j.cnki.11-5547/r.2020.21.009

Analysis of the influence of the treatment of hypothyroidism during pregnancy on the prognosis of mother and infant   SUN Pu， RUI Guang-hai， JIN Feng. Obstetrics and Gynecology Department， Fushun Second Peoples Hospital， Fushun 113001， China

【Abstract】 Objective   To discuss the influence of the treatment of hypothyroidism during pregnancy on the prognosis of mother and infant. Methods   A total of 98 pregnant women with hypothyroidism were randomly divided into control group and observation group， with 49 cases in each group. The control group received diet， exercise and other health guidance， and the observation group received levothyroxine sodium on the basis of the control group. The thyroid hormone level after treatment， delivery mode， maternal and mother-infant outcome， neonatal indicators were compared between the two groups. Results   After treatment， serum free triiodothyronine （FT3）， serum free thyroxine （FT4） levels of the observation group were higher than those of the control group， and thyroid stimulating hormone （TSH） level was lower than that of the control group， and the difference was statistically significant （P<0.05）. The natural childbirth rate 67.35% of the observation group was obviously higher than that of the control group 42.86%， and cesarean section rate 20.41% was obviously lower than that of the control group 38.78%， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in spontaneous abortion rate， vaginal midwifery rate between the two groups （P>0.05）. The incidence of mother， fetus/newborn of the observation group were 12.24% and 10.20% respectively， which were obviously lower than those of the control group 28.57% and 26.53%， and the difference was statistically significant （P<0.05）. The gestational age， birth weight and Apgar score of newborns in the observation group were better than those in the control group， and the difference was statistically significant （P<0.05）. Conclusion   Treatment of hypothyroidism during pregnancy can effectively improve the level of thyroid hormones， increase the rate of natural childbirth， reduce the incidence of mother-infant complications， improve the birth quality of newborns， and reduce the incidence of adverse pregnancy outcomes， which has positive clinical significance.

【Key words】 Hypothyroidism; Pregnancy; Levothyroxine sodium; Prognosis of mother and infant

临床研究显示， 妊娠期女性是甲状腺功能代谢异常的高发人群， 甲减是常见的甲状腺疾病之一， 会给母婴健康带来明显负面影响， 可造成多种不良妊娠结局的发生， 如早产、胎盘早剥、胎膜早破、低体重儿、小于胎龄儿、产后出血等。由于妊娠期女性的生理功能较为特殊， 对碘的摄入需求量较高， 更容易发生碘缺乏， 导致甲减的发生率较高[1]。但妊娠期甲减的治疗需十分谨慎， 不当治疗可导致胎死宮内、胎儿生长受限、早产、胎儿发育迟缓、新生儿智力低下等不良妊娠结局[2]。因此， 临床对妊娠期甲减的治疗既要确保疗效， 又要确保安全性， 以降低不良妊娠结局的风险。常规饮食及运动教育虽在一定程度上能改善机体代谢情况， 但总体效果一般。左甲状腺素钠属于新型甲减替代治疗药物， 有助于恢复甲状腺激素水平， 改善妊娠结局[3]。……