【摘要】 目的以妊娠期甲状腺功能减退症患者为研究对象,比较亚临床和临床甲减左甲状腺素钠(L-T4)治疗剂量在不同孕期的变化,以期对妊娠期L-T4的补充提供不同的参考依据。方法观察56例亚临床甲减和37例临床甲减妊娠期患者L-T4的剂量,比较不同妊娠周期两类患者L-T4需求量的变化。结果亚临床甲减患者在妊娠12周和20周达到L-T4饱和剂量的人数比例分别为17.9%和21.4%,而在临床甲减组中仅分别有10.8%和16.2%,两组中共约95.0%的患者在≤28周时达到饱和剂量;整个妊娠期内,亚临床甲减组L-T4总增加剂量百分比均较临床甲减组高,分别为第12周(54.55%vs 36.25%,t=2.621,P=0.010)、第20周(86.74%vs 55.04%,t=2.873,P=0.005)、第28周(111.81%vs 81.53%,t=2.224,P=0.029)和第36周(112.6%vs 82.88%,t=2.150,P=0.034)。结论不同类型甲减患者L-T4替代治疗的剂量变化规律有所差异,临床甲减患者更需密切监测甲状腺激素水平和增加剂量直至妊娠28周,而亚临床甲减患者L-T4剂量增加率较临床甲减高。更多还原

【Abstract】 Objective To compare the changes of levothyroxine(L-T4) dose in pregnant women with subclinical and overt hypothyroidism,so as to provide evidence for L-T4 supplement at gestational period.Methods The variations of L-T4 doses were observed and compared between 56 cases with subclinical hypothyroidism and 37 cases with overt hypothyroidism during different pregnant periods.Results In the subclinical hypothyroidism group,there were 17.9%and 21.4%cases reaching definitive therapeutic dosage in the 12 th and 20 th week of pregnancy,respectively,and there were 10.8%and 16.2%in the overt hypothyroidism group.In two groups,about 95.0%cases reached definitive therapeutic dosage within 28 th week.In the subclinical hypothyroidism group,the increased dose percent(L-T4 final dose/L-T4 dose before pregnancy,%) was higher than in the other group during the whole pregnancy,and they were 12 th week(54.55%vs 36.25%,t=2.621,P=0.010),20 th week(86.74%vs55.04%,t = 2.873,P = 0.005),28 th week(111.81%vs 81.53%,t =2.224,P = 0.029) and 36 th week(112.6%vs 82.88%,t- 2.150,P = 0.034),respectively.Conclusion During the pregnancy,the dose variations of L-T4 substitutive therapy are different among cases of different types.The thyroid hormone level and dose increase should be monitored more closely until 28 th week for cases of overt hypothyroidism.The increased dose percent is higher in cases of subclinical hypothyroidism.更多还原