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目的探讨高剂量左旋甲状腺素对妊娠合并甲状腺功能减退症患者叶酸、血脂水平及妊娠结局的影响。方法收集2015年1月-2016年1月就诊的妊娠合并甲状腺功能减退症患者172例,随机分为研究组与对照组,每组86例。研究组给予常规治疗联合高初始剂量左旋甲状腺素治疗,对照组给予常规治疗联合低初始剂量左旋甲状腺素治疗。观察并比较两组患者的叶酸、血脂水平及妊娠结局。结果研究组中,治疗前与治疗后血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异均有统计学意义(均P<0.05)。对照组中,治疗前与治疗后血清TG、TC、LDL-C水平比较,差异均有统计学意义(均P<0.05);治疗前与治疗后血清HDL-C水平比较,差异无统计学意义(P>0.05)。治疗后,研究组与对照组血清TG、TC、HDL-C、LDL-C水平比较,差异均有统计学意义(均P<0.05)。两组治疗前后血清叶酸水平比较差异均有统计学意义(均P<0.05)。治疗后,两组血清叶酸水平比较差异有统计学意义(均P<0.05)。两组患者妊娠期高血压疾病(HDCP)及胎盘早剥发生率比较差异均无统计学意义(均P>0.05);两组患者胎儿窘迫及早产发生率比较差异均有统计学意义(均P<0.05)。结论高剂量左旋甲状腺素治疗妊娠合并甲状腺功能减退症患者更有利于改善叶酸、血脂水平及妊娠结局。
Objective To investigate the effect of high-dose levothyroxine on folic acid, blood lipid and pregnancy outcome in patients with hypothyroidism during pregnancy. Methods 172 cases of hypothyroidism during pregnancy between January 2015 and January 2016 were randomly divided into study group and control group with 86 cases in each group. The study group received conventional therapy combined with high initial dose of L-thyroxine and the control group received conventional therapy combined with low initial dose of L-thyroxine. Observe and compare the two groups of patients with folic acid, blood lipid levels and pregnancy outcomes. Results In the study group, the levels of serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) There was statistical significance (all P <0.05). The levels of TG, TC and LDL-C in the control group before and after treatment were significantly different (all P <0.05). There was no significant difference in serum HDL-C levels between before and after treatment (P> 0.05). After treatment, the levels of serum TG, TC, HDL-C and LDL-C in study group and control group were significantly different (all P <0.05). Before and after treatment, serum folate levels were significantly different (all P <0.05). After treatment, the levels of serum folate in the two groups were significantly different (all P <0.05). There was no significant difference in the incidence of HDCP and placental abruption between the two groups (all P> 0.05). There was significant difference between the two groups in the incidence of fetal distress and preterm birth (P <0.05). Conclusions High-dose L-thyroxine treatment for pregnant women with hypothyroidism is more conducive to improve the folic acid, blood lipid levels and pregnancy outcomes.