妊娠期甲状腺减退患者妊娠期间左旋甲状腺素钠替代剂量探讨

doi:10.3969/j.issn.1004-583X.2016.06.020

临床荟萃

妊娠期甲状腺减退患者妊娠期间左旋甲状腺素钠替代剂量探讨

1.上海市闵行区浦江社区卫生服务中心妇产科，上海 201112；2.复旦大学附属上海市第五人民医院内分泌科，上海 200240

收稿日期:2016-01-25 出版日期:2016-06-05 发布日期:2016-06-06
通讯作者: 通信作者:刘军,Email:liujun@5thhospital.com
基金资助:
上海市卫生和计划生育委员会课题(201440514)

Levothyroxine replacement dose in patients with hypothyroidism during pregnancy

1.Department of Obstetrics and Gynecology， Shanghai Pujiang Community Health Center， Shanghai 201112， China;
2. Department of Endocrinology， Shanghai Fifth People's Hospital of Fudan University， Shanghai 200240， China

Received:2016-01-25 Online:2016-06-05 Published:2016-06-06
Contact: Corresponding author: Liu Jun， Email: liujun@5thhospital.com

摘要/Abstract

摘要： 目的探讨妊娠甲状腺功能减退症(甲减)妊娠期间左旋甲状腺素钠替代剂量。方法 2014年3月至
2015年3月入选在我院分娩的274例妊娠合并甲减孕妇,其中亚临床型甲减组(SHT)207例,临床型甲减组(HT)67
例,以妊娠早期促甲状腺激素(TSH)<2.5mU/L,妊娠中晚期TSH<3.0mU/L为治疗目标,根据TSH 及孕周变化
予调整左旋甲状腺素钠治疗剂量。并根据TSH 水平分为TSH1 组,TSH3~5mU/L,TSH2 组,TSH5~8mU/L,
TSH3 组,TSH8~10mU/L,TSH4 组,TSH10~15mU/L,TSH5 组,TSH15~20 mU/L 和TSH6 组,TSH>20
mU/L。结果各组达治疗目标后,SHT 组T1、T2 和T3 期,左旋甲状腺素钠剂量分别为:(52.26±19.43)μg、
(56.69±20.58)μg和(56.76±19.99)μg;HT组在T1、T2 和T3 期,左旋甲状腺素钠剂量分别为:(64.58±50.26)
μg、(66.67±47.64)μg和(65.91±34.06)μg;TSH1 组-TSH6 组左旋甲状腺素钠剂量分别为(45.65±16.08)μg、
(72.32±14.85)μg、(75.00±13.06)μg、(112.5±53.03)μg、(137.5±23.18)μg和(150.00±23.13)μg;T1、T2 和
T3 妊娠期TSH2、TSH3、TSH4 和TSH5 组左旋甲状腺素钠剂量高于TSH1 组(P <0.05);TSH4、TSH5 和TSH6 组
左旋甲状腺素钠片剂量高于TSH2 组(P <0.05);TSH4、TSH5 和TSH6 组高于TSH3 组(P <0.05);TSH5 和
TSH6 组高于TSH4 组(P <0.05);TSH6 组高于TSH5 组(P <0.05)。结论妊娠期临床型甲减左旋甲状腺素钠
剂量在T1、T2 和T3 妊娠期均高于亚临床型甲减(P <0.05)。随着TSH 水平增高,所需左旋甲状腺素钠明显增加
(P <0.05)。

关键词: 甲状腺功能减退症, 妊娠, 甲状腺素

Abstract:

ObjectiveTo explore the levothyroxine dose in patients with hypothyroidism during pregnancy. MethodsA total of 274 pregnant subjects with hypothyroidism including 207 patients with subclinical hypothyroidism (SHT) and 67 patients with clinical hypothyroidism (HT) were enrolled in this study from March 2014 to March 2015. According to thyrotrophic (TSH) levels， the levothyroxine dose was adjusted to reach the targets with the first trimester TSH ranging 0.12.5 mU/L， the second trimester(T2) TSH ranging 0.23.0 mU/L and the third trimester(T3) TSH ranging 0.33.0 mU/L. The subjects were divided into different groups on the basis of TSH levels， including TSH1 group: TSH 35 mU/L， TSH2 group: TSH 58 mU/L， TSH3 group: TSH 810 mU/L， TSH4 group: TSH 1015 mU/L， TSH5 group: TSH 1520 mU/L and TSH6 group: TSH>20 mU/L. ResultsThe levothyroxine doses were respectively (52.26±19.43) μg in T1 period，( 56.69±20.58) μg in T2 period and (56.76±19.99) μg in T3 period in subclinical hypothyroidism， and respectively (64.58±50.26) μg in T1 period，(66.67±47.64) μg in T2 period and （65.91±34.06） μg in T3 period in clinical hypothyroidism. The doses of levothyroxine were （45.65±16.08） μg，（72.32±14.85） μg，（75.00±13.06) μg， (112.5±53.03) μg，(137.5±23.18) μg and (150.00±23.13) μg from TSH1 group to TSH6 group， respectively. The doses of levothyroxine in TSH2， TSH3， TSH4 and TSH5 groups were significantly higher than that of TSH1 group during T1 to T3 trimester (P<0.05). The doses of levothyroxine in TSH4， TSH5 and TSH6 groups were significantly higher than that of TSH2 group (P<0.05). The doses of levothyroxine in TSH4， TSH5 and TSH6 groups higher than TSH3 group (P<0.05); The doses of levothyroxine in TSH5 and TSH6 groups were significantly higher than that of TSH4 group (P<0.05). The dose of levothyroxine in TSH6 group were significantly higher than that of TSH5 group (P<0.05). ConclusionThe levothyroxine (LT4) dose in clinical hypothyroidism in T1， T2 and T3 trimester were significantly higher than those in subclinical hypothyroidism (P<0.05). The dose of levothyroxine sodium increased significantly accompanied by the increased TSH level during pregnancy (P<0.05).

Key words: hypothyroidism, pregnancy, thyroxine

陈琳1,2,刘军2,庄婵娟1,李桂梅1,邓冬梅1. 妊娠期甲状腺减退患者妊娠期间左旋甲状腺素钠替代剂量探讨[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2016.06.020.

Chen Lin1，2， Liu Jun2， Zhuang Chanjuan1， Li Guimei1， Deng Dongmei1. Levothyroxine replacement dose in patients with hypothyroidism during pregnancy[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2016.06.020.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2016.06.020

https://huicui.hebmu.edu.cn/CN/Y2016/V31/I6/669

[1]	马光宇, 罗慧娟, 王冬菊, 肖小敏. 黄芩苷治疗糖尿病及其并发症的研究进展[J]. 临床荟萃, 2023, 38(8): 757-762.
[2]	唐婷婷, 刘燕, 王春梅, 汪淼芹, 王春燕. 妊娠期糖尿病孕妇自我管理行为与生活质量[J]. 临床荟萃, 2023, 38(12): 1125-1130.
[3]	迟秀娥, 张倩, 李文东, 王元松, 康静蕊. 误诊为癫痫的假性甲状旁腺功能减退症Ia型1例并文献复习[J]. 临床荟萃, 2022, 37(9): 827-830.
[4]	吴路路, 王瑞亚, 苏林, 冯静. 孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值[J]. 临床荟萃, 2022, 37(8): 713-716.
[5]	齐琪, 江黎晨, 孙蓉, 胡红琳, 章秋. 妊娠中晚期孕妇血清Gremlin1水平变化及其对妊娠期糖尿病的影响[J]. 临床荟萃, 2022, 37(3): 257-261.
[6]	冯少敏, 韩亚军, 霍琰. 人体成分分析在妊娠期糖尿病中的应用[J]. 临床荟萃, 2022, 37(3): 285-288.
[7]	左秀秀, 侯天华, 王宏祥. 亚临床甲状腺功能减退与慢性收缩性心力衰竭患者预后关系的meta分析[J]. 临床荟萃, 2022, 37(10): 905-911.
[8]	王婧, 许芳芳, 刘小转. 妊娠合并主动脉夹层6例回顾性分析[J]. 临床荟萃, 2022, 37(1): 52-56.
[9]	才可新, 郭宏举, 于淑霞, 常李荣. 左旋甲状腺素对妊娠期亚临床甲状腺功能减退症妊娠结局影响的荟萃分析[J]. 临床荟萃, 2021, 36(9): 773-777.
[10]	石瑶, 王虎, 陈敏, 李玉玲. 南充地区妊娠期糖尿病危险因素及妊娠结局分析[J]. 临床荟萃, 2021, 36(9): 795-798.
[11]	王朦朦, 王颖, 陈赵静, 徐贤荣, 杨军, 李红娟. 门冬胰岛素联合维生素D治疗对妊娠期糖尿病患者血糖水平及围产儿并发症影响Meta分析[J]. 临床荟萃, 2021, 36(7): 581-586.
[12]	周艺璇, 林伟钊, 李瑞满. 同型半胱氨酸与妊娠期高血压疾病相关性的meta分析[J]. 临床荟萃, 2021, 36(2): 101-106.
[13]	郑军霞, 欧靖华. uKIM-1、uL-FABP水平预测妊娠高血压综合征患者早期肾功能损伤的价值[J]. 临床荟萃, 2021, 36(12): 1102-1105.
[14]	尤牧, 蔡满红. TPOAb、HbA₁c、PLGF及血脂水平对妊娠期糖尿病孕妇妊娠结局的影响[J]. 临床荟萃, 2021, 36(1): 54-57.
[15]	蔡慧丽. 血清sST-2、BNP和PAPP-A在妊娠高血压合并心力衰竭中预测妊娠不良结局的临床价值[J]. 临床荟萃, 2020, 35(2): 139-143.

妊娠期甲状腺减退患者妊娠期间左旋甲状腺素钠替代剂量探讨

Levothyroxine replacement dose in patients with hypothyroidism during pregnancy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价