干预治疗对TPOAb阴性亚甲减孕妇妊娠结局的影响

目的:探讨干预治疗对不同TSH水平的妊娠期亚临床甲减合并甲状腺过氧化物酶(TPOAb)阴性孕妇妊娠结局的影响。方法:回顾性分析2016年1月1日至2016年12月31日在青岛大学附属医院产科分娩孕妇诊断为亚临床甲减且TPOAb阴性的孕妇不良妊娠结局的发生率,根据2011年(S1标准)及2017年(S2标准)美国甲状腺协会(ATA)指南对妊娠合并亚临床甲减推荐诊断的TSH水平不同分组,A组(4 m IU/LTSH10.0 m IU/L)131例,B组(TSH4 m IU/L,在T1期TSH2.5 m IU/L,T2、T3期TSH3.0 m IU/L)326例,根据是否接受左甲状腺素钠片(商品名:优甲乐)治疗,分为治疗组(295例)、未治疗组(194例),同时选取TPOAb阴性且甲状腺功能正常的孕妇(306例)作为对照组。结果:(1)依据S1、S2诊断标准,妊娠合并亚临床甲减的发生率分别为13.57%、3.6%,治疗率分别为39.67%、51.34%,不同诊断标准间比较差异具有统计学意义(P0.05)。(2)A组孕妇中,未治疗组妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、流产、早产、胎儿窘迫的发生率均高于治疗组及对照组,差异具有统计学意义(P0.05),而治疗组与对照组比较差异无统计学意义(P0.05)。未治疗组胎盘早剥、胎膜早破、胎儿畸形、低体重儿的发生率虽高于治疗组及对照组,但两两比较差异均无统计学意义(P0.05)。(3)B组孕妇未治疗组妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、流产、早产、胎儿窘迫、胎盘早剥、胎膜早破、胎儿畸形、低体重儿的发生率虽高于治疗组及对照组,三组及两两比较差异无统计学意义(P0.05)。结论:对于青岛地区TPOAb阴性的妊娠期亚临床甲减孕妇,4.0 m IU/LTSH10.0 m IU/L时,左甲状腺素钠片治疗能明显改善其不良妊娠结局。

Effect of Intervention Therapy on the Pregnancy Outcome of Pregnant Women with TPOAb-negative Hypothyroidism

ABSTRACT Objective: To investigate the effect of intervention therapy on the pregnancy outcome of pregnant women with thyroid gland peroxidase antibody(TPOAb)-negative subclinical hypothyroidism(SCH). Methods: The incidence of adverse pregnancy outcomes in pregnant women who delivered and diagnosed as SCH and TPOAb negative in the Affiliated Hospital of Qingdao University from January 1, 2016 to December 31, 2016 was retrospectively analyzed. According to the different TSH standard of American Thyroid Asso- ciation(ATA) published in 2011(S2) and 2017 (S2), the subjects were divided into the group A(4 mIU/L2.5 mIU/L, second-trimesterand third-trimesterand TSH>3.0 mIU/L, 326 case), The sub- jects were divided into the treatment group (295 cases) and the untreated group (194 cases) according to acceptance of Levothyroxine sodium tablets (trade name: Euthyrox), the pregnant women with TPOAb negative and normal thyroid function were selected as the con- trol group(306 cases) at the same time. Results: (1) According to S1 and S2 diagnostic criteria, the incidence of SCH in pregnancy was 13.57% and 3.6%, and the treatment rates were 39.67% and 51.34%, respectively. The difference was statistically significant between different diagnostic criteria(P<0.05). (2) In group A, the incidence of gestational hypertension, gestational diabetes mellitus (GDM), ane- mia, abortion, premature delivery, fetal distress in untreated group were higher than those in the treated group and the control group(P<0.05). No significant difference was found between treatment group and control group in the incidence of placental abruption, premature rupture of membranes, fetal malformation and low birth weight infants (P>0.05). The incidence of was higher in the untreated group than that in the treatment group and the control group, but the difference showed no significant difference(P>0.05). (3) In group B, the inci- dence of adverse pregnancy outcomes in the untreated group were higher than those in the treated group and the control group, but there was no significant difference between the three groups(P>0.05). Conclusion: For pregnant women with TPOAb-negative gestational sub- clinical hypothyroidism in Qingdao, when 4.0 mIU/L