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目的评估增加左旋甲状腺素(LT4)的剂量是否能降低促甲状腺素(TSH)高于早期妊娠推荐水平者的妊娠相关风险。方法选择2013年1月至2016年5月妊娠合并甲状腺功能减退(甲减)口服LT4治疗,且在妊娠早期初次检测TSH未达标的患者。研究对象分为两组:A组为LT4剂量在检测TSH后1周内增加,B组为LT4剂量保持稳定不变,比较两组妊娠不良事件的发生率。结果根据纳入排除标准,共收集79例患者,包括A组54例和B组25例妊娠期女性,两组临床一般资料比较无统计学差异(P均>0.05)。A组TSH检测和LT4剂量增加之间的时间间隔为(4.2±2.4)d。两组早产、妊娠期糖尿病、妊娠期高血压、先兆子痫或子痫、胎膜早破、胎盘早剥、低出生体重儿的发生率比较无统计学差异(P均>0.05)。同时发现A组流产率有较B组下降的趋势,但经校正χ2检验,差异尚无统计学意义(P=0.06)。两组均无先兆子痫、子痫或宫内发育迟缓以及新生儿死亡事件发生。结论对于妊娠早期甲减控制不佳的女性,及时增加口服LT4的剂量或有望减少流产发生的风险,能否达到有统计学意义的下降,尚需进一步扩大样本量进行探讨。
Objective To assess whether increasing doses of levothyroxine (LT4) can reduce the pregnancy-related risk of thyroid-stimulating hormone (TSH) above the recommended level for early pregnancy. Methods From January 2013 to May 2016, pregnant women with hypothyroidism (hypothyroidism) were treated with oral LT4 and the first trimester of pregnancy was performed to detect the patients who did not achieve TSH. Subjects were divided into two groups: the dose of LT4 in group A increased within 1 week after the detection of TSH, the dose of LT4 in group B remained stable, and the incidence of adverse pregnancy events in both groups was compared. Results According to inclusion criteria, a total of 79 patients, including 54 cases in group A and 25 cases in group B, were enrolled in the study. There was no significant difference in clinical data between the two groups (all P> 0.05). The time interval between TSH test and LT4 dose increase in group A was (4.2 ± 2.4) days. There was no significant difference in the incidence of preterm birth, gestational diabetes mellitus, gestational hypertension, preeclampsia or eclampsia, premature rupture of membranes, placental abruption and low birth weight infants (P> 0.05). At the same time, it was found that the abortion rate of group A tended to decrease compared with that of group B, but there was no significant difference (P = 0.06) after correction χ2 test. No preeclampsia, eclampsia or intrauterine growth retardation and neonatal death occurred in either group. Conclusions For women with poor control of hypothyroidism in early pregnancy, it is necessary to explore whether the timely increase of oral dose of LT4 may reduce the risk of miscarriage and achieve a statistically significant decrease.