干预措施对妊娠期亚临床甲状腺功能减退症孕妇及其子代的影响

发布时间：2018-02-28 13:29

本文关键词： 妊娠亚临床甲状腺功能减退症妊娠并发症产科结局发育商 Gesell　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采用左甲状腺素钠片干预妊娠期亚临床甲状腺功能减退症孕妇,观察干预措施对妊娠并发症、产科结局及其子代神经智力发育的影响。方法:共纳入研究对象46例,病例组21例,对照组25例。对照组不予特殊处理;病例组根据各自甲功给予适量L-T4,每4周检测一次甲功,将各自甲功尽快调至目标范围内。用调查问卷的形式收集孕妇及其子代人口统计学资料,随访观察孕妇妊娠并发症、产科结局。随访孕妇子代2-3岁时甲功、Gesell量表。收集整理数据,并统计分析。结果:1.病例组孕妇TSH水平高于对照组,差异有统计学意义(t=9.27,P=0.00)。病例组孕妇TPO-Ab阳性者例6例(28.6%),对照组孕妇TPO-Ab阳性者0例,二者阳性率有统计学差异(Χ2=5.89,P=0.02)。2.孕妇子代2-3岁甲功异常,主要表现为FT3和TSH的升高。FT3升高25例,其中病例组子代11例,对照组子代14例,二者比较无统计学差异(Χ2=0.06,P=0.81)。TSH升高5例,其中病例组子代3例,对照组子代2例,二者比较无统计学差异(Χ2=0.04,P=0.84)。其中1例FT3与TSH同时升高,为病例组子代。3.孕妇妊娠并发症及产科结局随访,病例组孕妇发现3例合并先兆流产,占14.3%,2例合并贫血,占9.5%,对照组孕妇未发现先兆流产、贫血。病例组与对照组妊娠并发症先兆流产、贫血发生率没有统计学差异(P0.05)。分娩方式,病例组顺产14例,占66.7%,剖宫产7例,占33.3%。对照组顺产15例,占60%,剖宫产10例,占40%,两组分娩方式无统计学差异(Χ2=0.22,P=0.64)。4.孕妇子代2-3岁神经智力发育商异常,病例组发现6例,占28.6%,对照组发现5例,占20%,二者比较无统计学差异(Χ2=0.46,P=0.50)。两组孕妇子代适应性发育商、大运动发育商、精细运动发育商、语言发育商、个人-社交发育商五个方面均无明显统计学差异(P0.05)。以发育商低于85视为异常,两组孕妇子代适应性发育商、大运动发育商、精细运动发育商、语言发育商、个人-社交发育商五个方面异常者无明显统计学差异(P0.05)。结论:1.尽早对妊娠期亚甲减孕妇予以干预,不仅有助于胎儿甲状腺发育,还对其下丘脑-垂体-甲状腺轴系建立正常反馈关系有益。2.尽早对妊娠期亚甲减孕妇予以干预,可以明显降低孕妇妊娠并发症。3.尽早对妊娠期亚甲减孕妇予以干预,有利于胎儿神经系统发育和婴幼儿阶段神经系统功能的完善。4.尽早筛查孕妇甲功并及早予以干预治疗,对孕妇及其子代均有所助益。
[Abstract]:Objective: to observe the effects of intervention measures on pregnant women with subclinical hypothyroidism and pregnant women with subclinical hypothyroidism. Methods: 46 subjects were included in the study. There were 21 cases in the case group and 25 cases in the control group. The pregnant women and their offspring were collected in the form of questionnaires, and the pregnant women's pregnancy complications were followed up and observed. Obstetrical outcome. Gesell scale at 2-3 years of follow-up. Data were collected and analyzed statistically. Results: 1. The TSH level of pregnant women in the case group was higher than that in the control group. The difference was statistically significant (P < 0.01). The positive rate of TPO-Ab was found in 6 cases of TPO-Ab positive in pregnant women and 0 cases in control group. There was a significant difference in the positive rate of TPO-Ab between the two groups (X ~ (2) 5.89). There was a significant difference between them (X ~ (2) 5.89). The main manifestations of abnormal nail work in the offspring of pregnant women aged 2-3 years were the increase of FT3 and TSH in 25 cases, and the increase of FT3 and TSH in 25 cases. There was no significant difference between the two groups (X ~ (2) 0.06), among them, there were 3 cases in the case group and 2 cases in the control group. There was no significant difference between the two groups (X _ (20.04) P ~ (0.84)) and TSH (n = 1), and there was no significant difference between the two groups (X _ (20.04) P ~ (0.84)), and there was no significant difference between the two groups (X _ (20.04) P ~ (0.84)). Pregnancy complications and obstetric outcomes of pregnant women were followed up. 3 cases of pregnant women with threatened abortion were found in the case group, accounting for 14.3% (2 cases) complicated with anemia, accounting for 9.5%. The pregnant women in the control group did not find threatened abortion. Anemia. There was no significant difference in the incidence of anemia between the case group and the control group (P 0.05). There were 14 cases of spontaneous delivery in the case group, accounting for 66.7%, and 7 cases of cesarean section, accounting for 33.3.The control group had 15 cases of spontaneous delivery, accounting for 60 cases, and 10 cases of cesarean section. There was no statistical difference between the two groups in the way of delivery (X ~ 2 ~ 2 ~ (0.22) P ~ (0.64)). 4. There were 6 cases (28.6%) in the case group and 5 cases (20%) in the control group. There was no statistical difference between the two groups (X ~ (22) 0.66) (X ~ (0.46) P ~ (0.50)). There was no significant difference between the two groups in the development quotient of the offspring of the two groups. There was no significant difference in the five aspects of major motor development quotient, fine motor developmental quotient, language development quotient and individual social development quotient. There was no significant difference among the five abnormal individuals: fine motor development quotient, language development quotient and individual social development quotient (P 0.05). Conclusion 1. Early intervention in pregnant women with hypothyroidism is not only helpful to the development of fetal thyroid gland, but also to the development of fetal thyroid. It is beneficial to establish a normal feedback relationship of hypothalamus-pituitary-thyroid axis. 2. To intervene in pregnant women with hypothyroidism as early as possible and to reduce the complications of pregnancy significantly. 3. To intervene in pregnant women with hypothyroidism during pregnancy as early as possible. It is beneficial to the development of fetal nervous system and the improvement of nervous system function in infantile stage. 4. Screening and intervention treatment of thyroid function of pregnant women as early as possible is helpful to pregnant women and their offspring.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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