L-T4替代治疗妊娠合并SCH患者的临床效果及有效剂量

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Abstract Objective To explore the initial dose selection and effect of Levothyroxine (L-T4) replacement therapy in pregnant patients with subclinical hypothyroidism (SCH). Methods A total of 100 pregnant patients with SCH diagnosed in Rugao People’s Hospital of Jiangsu Province from January 2016 to February 2018 were selected as the research subjects. They were divided into high-dose group (initial dose 50 μg, once a day) and low-dose group (initial dose 25 μg, once a day) according to drug dose, with 50 cases in each group. The levels of free triiodothyrogenine (FT3), free thyroxine (FT4), thyrotropin (TSH), folic acid (FA), nitric oxide (NO), endothelin-1 (ET-1), arterial flow mediated endothelium-dependent dilation (FMD), pregnancy outcome and perinatal outcome of two groups were compared before and after treatment. Results There were no significant differences in thyroid function and FA level between two groups before treatment (P > 0.05). After treatment, TSH level was lower than that before treatment, and FA level was higher than that before treatment; TSH level of high-dose group was lower than that of low-dose group, and FA level of high-dose group was higher than that of low-dose group, with statistical significances (all P < 0.05); and there were no significant differences in FT3 and FT4 levels between two groups (P > 0.05). Before treatment, there were no significant differences in NO, ET-1 and FMD levels between two groups (P > 0.05). After treatment; ET-1 level of two groups was lower than that before treatment, NO and FMD levels were higher than those before treatment. ET-1 level in high-dose group was lower than that in low-dose group, and NO and FMD levels in high-dose group were higher than those in low-dose group, with statistical significances (all P < 0.05). The incidence of obstetric complications in high-dose group was lower than that in low-dose group, with statistical significances (P < 0.05). The total incidence of fetal and perinatal adverse outcomes in high-dose group was lower than that in low-dose group, with statistical significances (P < 0.05). Conclusion L-T4 replacement therapy of 50 μg is more effective in regulating thyroxine level and endothelial function in pregnant patients with SCH than that of 25 μg, and has a positive effect on reducing the incidence of obstetric complications and fetal and perinatal adverse outcomes.

Key words： Pregnancy Subclinical hypothyroidism Levothyroxine Replacement therapy Dose

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	LIU Minglan1 XIAO Liming1 SHI Weihong2

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LIU Minglan1 XIAO Liming1 SHI Weihong2. Clinical effect and effective dose of L-T4 replacement therapy in pregnant patients with SCH[J]. 中国医药导报, 2021, 18(5): 80-83.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2021/V18/I5/80

[1] 左敏毅.左旋甲状腺素联合右归丸治疗妊娠合并亚临床甲状腺功能减退症患者的疗效及对Hcy、SOD、25-（OH）-D与叶酸水平的影响[J].中国妇幼保健，2018，33（3）：567-569.
[2] 周晓丽，李梅，贾晓慧.左旋甲状腺素片剂量对妊娠合并亚临床甲状腺功能减退者的疗效及妊娠影响[J].中国计划生育学杂志，2018，26（4）：32-35，44.
[3] 胡晓东，黄泽平.左旋甲状腺素治疗不同促甲状腺激素浓度老年亚临床甲状腺功能减退患者临床观察[J].临床军医杂志，2017，18（5）：525-527.
[4] 张娴.亚临床甲状腺功能减退对妊娠合并症的影响[J].中国病案，2018，19（6）：100-103.
[5] 孙秋桥，李慧娟.孕期甲状腺功能减退早期采用左旋甲状腺素对妊娠结果的影响[J].山西医药杂志，2018，47（5）：575-577.
[6] 郑斌.2015 ATA指南、2017ACR TI-RADS与Kwak TI-RADS三种不同分类标准在甲状腺结节风险评估中应用价值的比较[D].石家庄：河北医科大学，2019.
[7] 母雪飞，李毅，王贺阳，等.左旋甲状腺激素片在急性冠脉综合征合并亚临床甲状腺功能减退中应用临床研究[J].临床军医杂志，2018，46（5）：43-45.
[8] Shah R. In older adults with subclinical hypothyroidism，levothyroxine did not improve symptoms or tiredness [J]. Ann Intern Med，2017，167（4）：14.
[9] 吴跃跃，陈琳，黄新梅，等.妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J].中华内分泌代谢杂志，2017，33（3）：198-202.
[10] Li X，Wang Y，Guan Q，et al. The lipid-lowering effect of levothyroxine in patients with subclinical hypothyroidism：A systematic review and meta-analysis of randomized controlled trials [J]. Clin Endocrinol（Oxf），2017，87（1）：1-9.
[11] 李艳萍，李宇洁，赵春霞，等.左旋甲状腺素对妊娠合并甲减患者甲状腺功能和胎儿发育的影响[J].海南医学，2017，28（14）：2363-2365.
[12] Stott DJ，Gussekloo J，Kearney PM，et al. Study protocol；Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism - a randomised placebo controlled Trial（TRUST）[J]. BMC Endocr Disord，2017， 17（1）：6.
[13] 苏艳洁，廖滔.左旋甲状腺素片治疗妊娠合并甲状腺功能减退疗效及对子代智力发育的影响[J].中国计划生育学杂志，2018，26（4）：290-293.
[14] Liu L，Yu Y，Zhao M，et al. Benefits of Levothyroxine Replacement Therapy on Nonalcoholic Fatty Liver Disease in Subclinical Hypothyroidism Patients [J]. Int J Endocrinol，2017，2017：5753039.
[15] 乔侨，石礼红，包姿萍.左旋甲状腺素对妊娠合并甲状腺功能减退患者妊娠结局的影响[J].安徽医药，2017， 21（9）：1709-1711.
[16] 刘倩，张涛，李力.妊娠合并亚临床甲状腺功能减退症的早期治疗对妊娠结局的影响[J].中国妇幼保健，2016， 31（21）：4412-4414.
[17] 郭朋鸽，解冰洁，彭婷婷，等.妊娠合并亚临床甲状腺功能减退症及其治疗对妊娠结局的影响[J].中国妇幼保健，2016，12（31）：2428-2431.
[18] 邵侃，曲伸，陈美新，等.小剂量左甲状腺素干预治疗早期妊娠合并亚临床甲状腺功能减退症的临床疗效分析[J].中国医刊，2016，51（10）：45-48.
[19] 乔媛，董春萍，李晓燕.妊娠合并亚临床甲状腺功能减退症与妊娠结局的相关性分析[J].陕西医学杂志，2017， 46（9）：1244-1246.
[20] 黄丽，龚豪.妊娠合并亚临床甲状腺功能减退症对孕产妇妊娠结局及围产儿结局的影响[J].空军医学杂志，2017， 33（3）：187-189，192.
[21] 黄珂珂，沈晓亚.小剂量左甲状腺素对早期妊娠合并亚临床甲状腺功能减退症患者的疗效及安全性分析[J].中国计划生育和妇产科，2019，11（3）：59-61，69.
[22] 华彩红，郝尚辉，尹山兰，等.妊娠合并亚临床甲状腺功能减退者血清FGF-21及与血脂异常[J].中国计划生育学杂志，2019，27（4）：508-510.
[23] 王伟涛.监测血清甲状腺激素、Hcy、BNP水平在急性心肌梗死患者中的临床价值[J].中外医学研究，2019，17（34）：81-83.
[24] 陈琳，王君龙，刘晓丽，等.哈尔滨地区妊娠期甲状腺激素水平分析及参考范围研究[J].临床和实验医学杂志，2019，18（21）：2335-2338.
[25] 吕青青，孙丽芳，郑秀丽，等.早孕期妊娠合并亚临床甲状腺功能减退对妊娠期糖尿病的预测[J].中国妇产科临床杂志，2018，12（5）：419-422.
[26] 赵宇清.妊娠合并亚临床甲状腺功能低下的临床分析[J].中国药物与临床，2016，16（5）：100-102.
[27] 孙莹，舒立波，徐红波.甲状腺功能减退孕妇孕晚期脐血流S/D比值的变化[J].医学研究杂志，2017，46（4）：90-92.
[28] 荣蓉，王宏星.甲状腺过氧化物酶抗体对妊娠期亚临床甲状腺功能减退女性妊娠结局的影响[J].中国妇幼健康研究，2017，28（4）：400-402.