鲁琳琳 徐福彦

【摘要】 目的：探討妊娠期糖尿病（GDM）伴甲状腺功能减退孕妇采用甲状腺激素替代疗法治疗的临床效果。方法：选取2022年1月—2023年1月山东颐养健康集团淄博医院收治的92例GDM伴甲状腺功能减退孕妇，根据不同替代剂量分成高剂量组（n=46）与低剂量组（n=46）。低剂量组给予低剂量甲状腺激素替代疗法，高剂量组给予高剂量甲状腺激素替代疗法。比较两组甲状腺功能、糖脂代谢指标及妊娠结局。结果：治疗后两组促甲状腺激素（TSH）水平均降低，游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）水平均升高，高剂量组TSH水平更低，FT3、FT4水平更高，差异均有统计学意义（P<0.05）；治疗后两组甘油三酯（TG）、总胆固醇（TC）、空腹胰岛素（FINS）、空腹血糖（FPG）水平均降低，高剂量组较低剂量组均更低，差异均有统计学意义（P<0.05）；高剂量组不良妊娠结局发生率（10.87%）与低剂量组（17.39%）比较，差异无统计学意义（P>0.05）。结论：相较于低剂量甲状腺激素替代疗法，高剂量甲状腺激素替代疗法应用于GDM伴甲状腺功能减退孕妇中，能够更好地改善甲状腺功能及糖脂代谢指标，安全性较高。

【关键词】 妊娠期糖尿病 甲状腺功能减退 甲状腺激素替代疗法

Clinical Effect of Different Dose Thyroid Hormone Replacement Therapy in the Treatment of Gestational Diabetes Mellitus with Hypothyroidism/LU Linlin， XU Fuyan. //Medical Innovation of China， 2024， 21（07）： 0-036

[Abstract] Objective： To investigate the clinical effect of thyroid hormone replacement therapy in gravida with gestational diabetes mellitus （GDM） with hypothyroidism. Method： A total of 92 gravidas with GDM with hypothyroidism admitted to Zibo Hospital of Shandong Yiyang Health Group from January 2022 to January 2023 were selected and divided into high-dose group （n=46） and low-dose group （n=46） according to different replacement doses. The low-dose group was given low-dose thyroid hormone replacement therapy， and the high-dose group was given high-dose thyroid hormone replacement therapy. Thyroid function， glycolipid metabolism indexes and pregnancy outcome were compared between the two groups. Result： After treatment， the levels of thyroid stimulating hormone （TSH） were decreased in both groups， the levels of free triiodothyronine （FT3） and free thyroxine （FT4） were increased in both groups， and the TSH level in high-dose group was lower， and FT3 and FT4 levels in high-dose group were higher， the differences were statistically significant （P<0.05）. After treatment， the levels of triglyceride （TG）， total cholesterol （TC）， fasting insulin （FINS） and fasting plasma glucose （FPG） in both groups were decreased， and those in the high-dose group were lower than those in the low-dose group， the differences were statistically significant （P<0.05）. There was no significant difference in the incidence of adverse pregnancy outcome between the high dose group （10.87%） and the low dose group （17.39%） （P>0.05）. Conclusion： Compared with low-dose thyroid hormone replacement therapy， the application of high-dose thyroid hormone replacement therapy in gravida with GDM with hypothyroidism can better improve thyroid function and glycolipid metabolism indexes， and has higher safety.

[Key words] Gestational diabetes mellitus Hypothyroidism Thyroid hormone replacement therapy

First-author's address： Department of Obstetrics and Gynecology， Zibo Hospital of Shandong Yiyang Health Group， Zibo 255120， China

doi：10.3969/j.issn.1674-4985.2024.07.008

妊娠期糖尿病（GDM）属于妊娠期常见合并症之一，以糖代谢异常为主要病理特征，如果机体内血糖长期处于高水平状态，将会对多器官功能造成损伤，如甲状腺功能，因此部分GDM孕妇伴有不同程度的甲状腺功能减退（简称甲减）症状[1]。甲减会对孕妇机体糖脂代谢造成不良影响，促使GDM病情进一步加重，若不及时治疗，不仅会影响胎儿神经功能发育，还会引起妊娠期高血压等并发症，增加不良妊娠结局发生风险，严重威胁母婴安全[2]。目前，临床主要采用甲状腺激素替代疗法治疗甲减，以左甲状腺素钠片为常用药物，能够为机体补充外源性甲状腺素，促进甲状腺功能恢复，抑制病情发展[3]。……