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目的探讨妊娠合并亚临床甲状腺功能减退症(SCH)及其应用左旋甲状腺素片(L-T4)治疗对妊娠结局的影响,为妊娠合并SCH的诊断和治疗提供理论依据。方法选取2012年3月-2014年12月在山西医科大学第一医院产科住院并分娩的529例妊娠合并SCH单胎活产孕妇为研究对象,采用面对面询问方式进行问卷调查,收集一般人口学特征、孕产史、环境和生活方式等资料,查阅妊娠期合并症(妊娠期糖尿病、妊娠期高血压疾病)、分娩情况、用药情况及妊娠结局等信息。采用多因素非条件Logistic回归分析,探讨妊娠不同阶段合并SCH及是否服药对妊娠结局(早产、小于胎龄儿、低出生体重儿、巨大儿)的影响。结果与妊娠早中期合并SCH组孕妇相比,妊娠晚期合并SCH组早产(10.0%与1.4%,χ~2=18.673,P<0.001)和低出生体重儿(11.6%与1.9%,χ~2=19.010,P<0.001)的发生率较高;妊娠合并SCH服药组早产(0.8%与9.8%,χ~2=20.782,P<0.001)、低出生体重儿(1.7%与11.1%,χ~2=18.031,P<0.001)的发生率均低于妊娠合并SCH未服药组。多因素Logistic回归分析结果显示:规律服药是妊娠合并SCH孕妇发生不良妊娠结局的保护因素,可明显降低早产的发生风险,其OR值(95%CI)为0.168(0.034~0.826)。结论规律服药可降低妊娠合并SCH孕妇早产的发生风险,从而改善妊娠结局。
Objective To investigate the effect of pregnancy associated with subclinical hypothyroidism (SCH) and its application of L-T4 on the outcome of pregnancy, and to provide a theoretical basis for the diagnosis and treatment of pregnancy complicated with SCH. Methods From March 2012 to December 2014, 529 pregnant women with single pregnancy with pregnancy were hospitalized in Maternity and Child Health Center of the First Hospital of Shanxi Medical University from March 2012 to December 2014. The questionnaires were conducted by face-to-face interrogation to collect general demographic characteristics , History of pregnancy and childbirth, environment and lifestyle information, access to information on gestational complications (gestational diabetes, gestational hypertension), childbirth, medication and pregnancy outcomes. Multivariate non-conditional Logistic regression analysis was performed to investigate the effect of combined SCH and medication on pregnancy outcome (preterm birth, infants less than gestational age, low birth weight infants, macrosomia) at different stages of pregnancy. Results Compared with pregnant women with SCH in the early and middle stages of pregnancy, preterm labor (10.0% vs 1.4%, χ ~ 2 = 18.673, P <0.001) and low birth weight children (11.6% vs 1.9%, χ ~ 2 = 19.010, P <0.001). The incidences of premature delivery (0.8% vs 9.8%, χ ~ 2 = 20.782, P <0.001) and low birth weight children (1.7% vs 11.1%, χ ~ 2 = 18.031, P <0.001) were lower than that of pregnant women without SCH. Multivariate logistic regression analysis showed that regular medication was a protective factor of adverse pregnancy outcomes in pregnant women with SCH and pregnant women with SCH, which could significantly reduce the risk of preterm delivery. The odds ratio (95% CI) was 0.168 (0.034-0.826). Conclusion Regular medication can reduce the risk of preterm birth in pregnant women with SCH and improve the pregnancy outcome.