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目的观察左甲状腺素钠片对妊娠伴甲状腺功能减退患者血脂与甲状腺功能水平的影响。方法 52例妊娠伴甲状腺功能减退患者随机分为对照组及试验组,每组26例。对照组给予常规治疗,包括适量补充碘盐、足量优质蛋白质、适当低脂饮食等;试验组在对照组的基础上口服左甲状腺素钠片50μg,每日1次,2组均持续治疗至分娩。比较2组患者治疗前后血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平、血清促甲状腺激素(TSH)、游离甲状腺素(FT_4)、游离三碘甲状腺原氨酸(FT3)水平及妊娠期并发症的发生率。结果治疗后,试验组和对照组TC分别为(4.22±0.59),(5.32±0.69)mmol·L~(-1),TG分别为(2.11±0.25),(2.84±0.39)mmol·L~(-1),LDL-C分别为(2.18±0.31),(3.11±0.37)mmol·L~(-1),HDL-C分别为(1.82±0.26),(1.56±0.22)mmol·L~(-1),TSH分别为(2.03±0.25),(2.45±0.34)pmol·L~(-1),FT4分别为(18.43±2.61),(10.84±1.57)pmol·L~(-1),FT3分别为(5.73±0.81),(3.35±0.47)pmol·L~(-1),试验组与对照组相比,差异有统计学意义(P<0.05)。对照组发生妊娠期高血压2例,妊娠期糖尿病1例,肝内胆汁淤积1例,胎儿生长受限2例,妊娠期并发症发生率为23.08%(6/26例);试验组发生妊娠期高血压1例,妊娠期糖尿病1例,肝内胆汁淤积1例,妊娠期并发症发生率为11.54%(3/26例),差异无统计学意义(P>0.05)。结论左甲状腺素钠片能显著降低妊娠伴甲状腺功能减退患者的血脂水平,改善甲状腺功能,降低妊娠期并发症的发生率。
Objective To observe the effects of levothyroxine sodium tablets on serum lipids and thyroid function in patients with hypothyroidism during pregnancy. Methods 52 cases of pregnancy with hypothyroidism were randomly divided into control group and experimental group, with 26 cases in each group. The control group was given routine treatment, including appropriate amount of iodized salt, adequate high-quality protein, appropriate low-fat diet; the experimental group in the control group on the basis of oral levothyroxine sodium tablets 50μg, 1 day, childbirth. The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and serum thyrotropin (TSH) , Free thyroxine (FT_4), free triiodothyronine (FT3) and the incidence of complications during pregnancy. Results After treatment, the TCs in the test group and the control group were (4.22 ± 0.59) and (5.32 ± 0.69) mmol·L -1, respectively, and were 2.11 ± 0.25 and 2.84 ± 0.39 mmol·L -1, (-1), LDL-C were (2.18 ± 0.31) and (3.11 ± 0.37) mmol·L -1 respectively, and the HDL-C levels were 1.82 ± 0.26 and 1.56 ± 0.22 mmol·L ~ (-1) and TSH were (2.03 ± 0.25) and (2.45 ± 0.34) pmol·L -1, FT4 were (18.43 ± 2.61) and (10.84 ± 1.57) pmol·L -1, respectively , FT3 were (5.73 ± 0.81) and (3.35 ± 0.47) pmol·L -1, respectively. The difference between the experimental group and the control group was statistically significant (P <0.05). 2 cases of gestational hypertension, 1 case of gestational diabetes mellitus, 1 case of intrahepatic cholestasis, 2 cases of fetal growth restriction and 23.08% (6/26 cases) gestational complications occurred in the control group. Pregnancy occurred in the experimental group 1 case of hypertension, 1 case of gestational diabetes mellitus, 1 case of intrahepatic cholestasis, the incidence of complications in pregnancy was 11.54% (3/26 cases), the difference was not statistically significant (P> 0.05). Conclusion Levothyroxine sodium tablets can significantly reduce the blood lipid levels of pregnant women with hypothyroidism, improve thyroid function and reduce the incidence of complications during pregnancy.