陈静　　王琼　　毛亚飞　　孙娜芬　　郑敏　　陈华

[關键词] 真武汤;左旋甲状腺素;亚临床甲状腺功能减退症;妊娠结局

[中图分类号] R581.2          [文献标识码] B          [文章编号] 1673-9701（2021）14-0147-04

Effect of Zhenwu Decoction and levothyroxine tablets on the pregnancy of women with subclinical hypothyroidism

CHEN Jing   WANG Qiong   MAO Yafei   SUN Nafen   ZHENG Min   CHEN Hua

Department of Pharmacy，Zhoushan Women and Children′s Hospital in Zhejiang Province，Zhoushan   316000，China

[Abstract] Objective To investigate the effect of Zhenwu Decoction combined with levothyroxine on pregnancy outcome of pregnant women with subclinical hypothyroidism. Methods A total of 132 pregnant women with subclinical hypothyroidism who were admitted to our hospital from January 2017 to January 2019 were selected as the research subjects. They were divided into the western medicine group and the Chinese and western medicine combination group using a random number table， with 66 cases in each group. Pregnant women in the western medicine group were given levothyroxine for treatment. The Chinese and western medicine combination group were given Zhenwu Decoction combined with levothyroxine for treatment. The clinical effects and pregnancy outcomes between the two groups were evaluated. The TCM symptom scores， folic acid， and serum thyroid hormone levels between the two groups before and after treatment were compared. Results After treatment， the total clinical effective rates of pregnant women in the western medicine group was 96.97%， which was higher than that of 77.27% in the Chinese and western medicine combination group. The difference between the two groups was statistically significant（P<0.05）. After treatment， the scores of thyroid pain， fatigue， memory decline， and irritability in the two groups were significantly lower than before treatment， and the difference was statistically significant（P<0.05）. However， there was no significant difference in the levels of FT3 and FT4 after the treatment between the two groups（P>0.05）. After the treatment， the TSH level in the Chinese and western medicine combination group was significantly lower than that in the control group， and the folic acid level was significantly higher than that in the control group， and the difference was statistically significant（P<0.05）. After the treatment， the total incidence of adverse pregnancy outcomes for pregnant women in the western medicine group was 18.18%， which was higher than  that of 4.55% in the Chinese and western medicine combination group. The difference between the two groups was statistically significant（P<0.05）. Conclusion Zhenwu Decoction combined with levothyroxine has a significant effect in the treatment of pregnant women with subclinical hypothyroidism， which can improve the clinical symptoms of the patients， reduce the TSH level and the incidence of adverse pregnancy outcomes.

[Key words] Zhenwu Decoction; Levothyroxine; Subclinical hypothyroidism; Pregnancy outcome

妊娠期亚临床甲状腺功能减退症（Subclinical hypothyroidism，SCH），以下简称亚甲减，是由多种原因引起的甲状腺激素合成、分泌或生物效应不足所致的内分泌疾病，是仅次于妊娠期糖尿病的第二大妊娠期内分泌疾病[1]。其主要的临床表现为疲劳、记忆力下降、易怒、皮肤干燥等。大量研究表明[2-3]，亚甲减易使孕妇产生不良妊娠结局，严重影响其身体健康。目前临床上常用西药进行治疗，其中左旋甲状腺素常用于治疗妊娠期亚甲减，但效果一般，且长期服用易产生心悸、烦躁等不良反应[4]。中医认为[5]，亚甲减是由于脾肾阳虚、水湿泛滥所致。真武汤是一首温补肾阳的方剂。因此，本研究旨在探讨真武汤联合左旋甲状腺素对亚甲减孕妇妊娠结局的影响，选取2017年1月至2019年1月在本院收治的亚甲减孕妇132例进行研究，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年1月至2019年1月在我院收治的亚甲减孕妇132例作为研究对象，应用随机数字表法分为西药组和中西药联合组，每组各66例。西药组初产妇26例，经产妇40例;年龄23～38岁，平均（30.58±6.39）岁;孕龄21～32周，平均（26.58±5.22）周;体质量指数（BMI）22～27 kg/m2，平均（24.62±2.51）kg/m2。中西药联合组初产妇27例，经产妇39例;年龄23～39岁，平均（30.61±6.40）岁;孕龄20～32周，平均（26.60±5.23）周;体质量指数（BMI）22～27 kg/m2，平均（24.63±2.52）kg/m2。所有参加患者对本次治疗均知情，并签署知情同意书。两组患者的一般资料比较，差异无统计学意义（P>0.05），具有可比性。

1.2 方法……