干预治疗对妊娠期亚临床甲减妊娠结局的影响

Effect of Intervention Therapy on the Pregnancy Outcome of Pregnant Women with Subclinical Hypothyroidism

摘要: 目的：研究干预治疗对妊娠期亚临床甲减妊娠结局的影响，探讨与甲状腺过氧化物酶抗体(TPOAb)的相关性。方法：选择2017年10月至2019年10月，就诊邵阳学院附属第二医院产科门诊，建档并定期产检的孕妇，根据甲状腺功能检测结果选取124例亚临床甲减(SCH)患者和600例对照组，将SCH患者随机分为治疗组和观察组后对比两组不良妊娠患病率的差异及其分别与对照组的差异是否存在统计学意义。同时将SCH组分为TPOAb阳性组和阴性组，分别将两组中治疗和观察的患者不良妊娠患病率及其与对照组的患病率进行对比，分析是否存在统计学差异。采用卡方检验进行率的比较，P < 0.05认为差异有统计学意义。结果：共1762例孕妇接受甲状腺功能检测，124例(7.04%)存在SCH，其中TPOAb阳性49例(39.52%)，阴性75例(60.48%)。未治疗的SCH患者不良妊娠率远高于对照组(P < 0.05)，但经过治疗可获得与对照组相似的预后(P > 0.05)；SCH患者合并TPOAb阳性经治疗，患病率低于未治疗者，差异存在统计学意义(P < 0.05)；合并TPOAb阴性者经治疗后不良妊娠的患病率低于未治疗者，差异无统计学意义(P > 0.05)。结论：妊娠期亚临床甲减患者经左甲状腺素钠片治疗可明显减少不良妊娠发生的几率，尤其是合并TPOAb阳性的患者。

Abstract: Objective: To investigate the effect intervention therapy on pregnancy outcome pregnant women with subclinical hypothyroidism and relevance to the state of thyroid TPOAb. Methods: Pregnant women who were enrolled in the department of obstetrics and gynecology of the Second Affiliated Hospital of Shaoyang University from October 2017 to October 2019 were selected for regular physical examination. According to the thyroid function test, 124 women with SCH and 600 cases without disease were chosen. SCH cases were randomly divided into the treated group and the observation group. The prevalence of these two groups and the control group was compared. The SCH group was further divided into the TPOAb positive and negative groups. Then respectively the prevalence of the treated group, the untreated group and the control group was compared as well. The comparison of rate was determinated by χ2 test. And differences were considered significant when P < 0.05. Results: By the end of the study, 1762 pregnant women were screened for thyroid function. There were 124 (7.04%) women with SCH, TPOAb positive 49 cases (39.52%), 75 cases (60.48%) of negative. The prevalence of the SCH untreated group was higher than the control group (P < 0.05), and the treated group got a similar prognosis (P > 0.05). In the TPOAb positive group, treated patients have lower prevalence than the untreated ones (P < 0.05). In the TPOAb negative group, treated patients have lower prevalence than the untreated ones, but there was no statistical significance (P > 0.05). Conclusion: Patients with subclinical hypothyroidism during pregnancy can significantly reduce the incidence of adverse pregnancy after treatment, especially the ones merging TPOAb positive.