摘要
目的：探讨妊娠甲状腺功能减退症（ HT）孕妇各期左甲状腺素（ L－T4）治疗达标剂量的变化规律。方法妊娠甲状腺功能减退孕妇38例，按妊娠前是否合并甲状腺功能减退症病史分组，妊娠前合并甲状腺功能减退者为A组（ n ＝16）；既往无甲状腺功能减退病史，妊娠早期初次筛检发现甲状腺功能减退者为B组（ n ＝22）。分别观察2组孕妇治疗期间药物剂量的调整及开始药物替代治疗前后甲状腺功能相关指标的变化。结果（1）与入组时比较，A组于妊娠2个月、3个月、6个月及9个月L－T4剂量增加（ t值分别为－3．929、－5．692、－2．935、－4．496， P均＜0．05），则B组无明显变化（ P ＞0．05）；在妊娠月份相同（2个月～9个月）的条件下，A 组所需的L－T4剂量明显高于B组（ t值分别为2．300、4．565、2．962、6．041、4．627、2．271、4．965、6．039、2．936， P均＜0．05）。（2）妊娠早期即需要增加L－T4剂量，妊娠各期L－T4剂量与入组时增加的百分比与甲减发生原因有关：桥本甲状腺炎后甲减中L－T4剂量于妊娠1个月、2个月时增加（ t值分别为－2．809及－3．261， P均＜0．05）；特发性甲减中L－T4剂量于妊娠1个月及2个月时明显增加（ t值分别为－3．320及－4．459， P均＜0．05）。（3）妊娠期甲减L－T4替代治疗的达标剂量受基线时TSH水平的影响，根据TSH的水平调整L－T4的剂量，甲状腺激素的需要量于中晚期调整剂量逐渐趋于稳定。结论妊娠前期或妊娠早期应尽快明确甲状腺功能，对合并甲状腺功能减退孕妇应尽快按照指南的要求调整L－T4的剂量于妊娠早期达标。
Objective To investigate levothyroxine （ L-T4 ） variation of standard dose treatment for hypothyroidism during each stage of pregnancy （ HT） women.Methods Thirty-eight cases of pregnancy and hypothyroidism women, accord-ing to before pregnancy whether complicated with hypothyroidism, they were divided into group A with history of early hypothy-roidism（ n =16）;group B with no previous history of early hypothyroidism but primary screening druing pregnancy found hy-pothyroidism （ n =22） .The changes of drug dosage adjustment and thyroid function before and after substitution treatment were observed in the 2 groups of pregnant women.Results （1） Compared with before enrollment, group A’s L-T4 was in-creased at 2 months, 3 months, 6 months and 9 months of pregnancy （ t =-3.929, t =-5.692, t =-2.935, t =-4.496, P〈0.05）, the group B had no significant changes （ P〉0.05）;at the same month of pregnancy（2 months to 9 months）,group A required higher dose of L-T4 than that in group B （ t =2.300, t =4.565, t =2.962, t =6.041, t =4.627, t =2.271, t =4.965, t =6.039, t =2.936, P〈0.05）.（2） In early pregnancy, it is needed to increase the L-T4 doses, and hypothyroidism during pregnancy increase the percentage of L-T4 dose and related to the etiology：Hashimotoˊs thy-roiditis：after hypothyroidismm L-T4 dose of 1 months, 2 months of pregnancy were increased （ t =-2.809, t =-3.261, respectively, P〈0.05）;idiopathic hypothyroidism, L-T4 doses at 1 months and 2 months of pregnancy were increased signifi-cantly （ t =-3.320, t =-4.459, respectively, P〈0.05）.（3） The effects of standard dose of L-T4 alternative treatment＆amp;nbsp;were affected by baseline TSH levels, according to TSH level to adjust L-T4 dose, requirement of thyroid hormone in the mid-dle and late period were gradually stabilized.Conclusion The first trimester of pregnancy or in early pregnancy, thyroid func-tion should be determined as soon as possible, for pregnant women with hypothyroidism, in accordance with the guidelines, L-T4 doses should be reached the standard as soon as possible in early pregnancy.
出处
《疑难病杂志》
CAS
2015年第5期468-471,475,共5页
Chinese Journal of Difficult and Complicated Cases
基金
内蒙古自治区自然科学基金项目(No.2012MS1131)
作者简介
通信作者：闫朝丽，E-mail：aliceyzl@126．com
