摘要:目的:探讨妊娠期甲状腺功能筛查的必要性及妊娠期亚临床甲状腺功能减退症(SCH)左旋甲状腺素(L-T4)替代治疗的安全性及有效性。方法:对2009年4月至2010年4月在我院产科做产前保健检查的孕20周以前的孕妇964例，进行甲状腺功能的筛查，将确诊SCH的孕妇分为治疗组和对照组，治疗组根据TSH水平，孕期予50~75ug LT4治疗，对照组不予干预，每隔4周复查两组孕妇TSH及TT4直至分娩，观察治疗组与对照组的围生期结局，进行统计学分析。结果:964例孕妇初次筛查TSH值范围在0.011~14.047mU/L之间，均数为1.568 mU/ L，P2.5为0.078 mU/ L，P5为0.190 mU/ L ，P95为3.568 mU/ L，P97.5为4.571 mU/ L;诊断临床甲减2例(发病率0.2%)，亚临床甲亢2例(发病率0.2%)，SCH68例(发病率7.05%);在接受L-T4治疗的23例SCH孕妇中，无1例治疗导致不良妊娠结局发生，SCH孕妇LT4治疗组与对照组围生期结局差异无统计学意义。结论:深圳市孕妇甲状腺功能异常的发病率偏高，故妊娠期甲状腺功能的筛查是非常必要的，孕期适量的L-T4替代治疗对母儿是安全的。Objective: To investigate the necessity for screening of thyroid function during pregnancy, and the safety and efficacy of gestational subclinical hypothyroidism levothyroxine replacement therapy. Methods: 964 pregnant women less than 20 weeks for obstetric examination from April 2009 to April 2010 were selected and accepted thyroid function screening. Subclinical hypothyroidism women were divided into the treatment group and control group. The treatment group received 50-75ug LT4 according to TSH level while the control group received no intervention. The levels of TSH and TT4 were reviewed every four weeks until delivery and perinatal outcomes were observed and analyzed statistically for the two groups. Results: TSH value for 964 cases of pregnant women first screening range from 0.011 to 14.047 mU/L, mean 1.568 mU/L, P2.5 0.078 mU/L, P5 0.190 mU/L, P95 3.568mU/L, P97.5 4.571mU/L.2 cases were diagnosed as clinical hypothyroidism(0.2% incidence),2 subclinical hyperthyroidism(0.2% incidence) and 68 subclinical hypothyroidism(7.05% incidence). No LT4 treatment adverse pregnancy outcome occurred for 23 SCH pregnant women. The difference of perinatal outcome between the treatment group and the control group was not statistically significant. Conclusions: The incidience of thyroid malfunction was high in pregnant women of Shenzhen City.It is necessary to screen the thyroid function during pregnancy and it is safe for mother and child to receive appropriate dose of levorotatory thyroid hormone replacement therapy during pregnancy period.
