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目的评估妊娠期合并亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)对胎儿宫内发育情况及妊娠结局的影响。方法回顾分析2013年1月—2015年6月本院妇产科收治的妊娠期合并SCH孕妇98例,根据是否接受药物干预进行分组:42例不接受药物治疗者为A组,56例接受左旋甲状腺素钠(sodium L-thyroxine,L-T4)治疗者为B组,随机抽取同期健康孕妇60名为C组,检测和对比3组调查对象的外周血甲状腺激素(thyroid stimulating hormones,TSH)水平、胎儿双顶径(biparietal diameter,BPD)变化及妊娠结局。计量资料用x—±s表示,3组比较采用方差分析,两两比较采用LSD法;计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果孕37周,B、C组的TSH均低于A组,差异均有统计学意义(均P<0.05),BPD高于A组,差异有统计学意义(P<0.05);孕产妇不良结局(自然流产、GDM、HDP、妊娠期贫血、胎膜早破及剖宫产)发生率低于A组,差异均有统计学意义(均P<0.05);B、C组的新生儿不良结局(FGR、胎儿宫内窘迫、胎儿畸形、低出生体重儿)发生率低于A组,且出生体重高于A组,差异均有统计学意义(均P<0.05);B组与C组各项指标比较,差异均无统计学意义(均P>0.05)。结论妊娠合并SCH对于胎儿宫内发育具有明显影响,可增加母婴并发症的发生率,早期积极应用L-T4干预治疗能够改善胎儿宫内发育状况及妊娠结局。
Objective To evaluate the effect of subclinical hypothyroidism (SCH) on intrauterine development and pregnancy outcome in pregnancy. Methods A retrospective analysis was performed on 98 pregnant women with pregnancy complicated with gynecology and obstetrics admitted in our hospital from January 2013 to June 2015. The patients were divided into groups according to whether they received drug intervention or not. Sixty-two healthy pregnant women of the same period were selected randomly as group C, and the level of thyroid stimulating hormones (TSH) in the three groups of patients was tested and compared with those of sodium L-thyroxine (L-T4) , Biparietal diameter (BPD) changes and pregnancy outcome. Measurement data with x- ± s said, the three groups were compared using analysis of variance, pairwise comparison using the LSD method; count data were compared using the χ2 test, P <0.05 for the difference was statistically significant. Results The TSH of group B and C were lower than that of group A at 37 weeks’ gestation, the differences were statistically significant (all P <0.05). BPD was higher than that of group A (P <0.05) The incidence of spontaneous abortion, GDM, HDP, gestational anemia, premature rupture of membranes and cesarean section were lower than those in group A (all P <0.05). The neonatal morbidity in groups B and C was poor The incidence of FGR, fetal distress, fetal malformation and low birth weight children was lower than that of group A, and the birth weight was higher than that of group A (all P <0.05). In group B and C The indicators were compared, the difference was not statistically significant (P> 0.05). Conclusions Pregnancy with SCH has a significant effect on fetal intrauterine growth, which can increase the incidence of maternal and infant complications. Early positive application of L-T4 intervention can improve fetal intrauterine growth and pregnancy outcomes.