碘营养干预联合左甲状腺素在妊娠期亚临床甲状腺功能减退症患者中的应用效果

doi:10.3760/cma.j.cn441417-20240701-01008

摘要/Abstract

摘要：

目的　研究碘营养干预联合左甲状腺素在妊娠期亚临床甲状腺功能减退症（甲减）患者中的应用效果。方法　本研究为随机对照试验。选取2022年1月至12月郑州市妇幼保健院亚临床甲减患者116例，按随机数字表法分为对照组（58例）和试验组（58例）。试验组年龄（28.45±2.14）岁；体重指数（body mass index，BMI）（25.15±1.32）kg/m²；孕周（9.41±0.92）周；孕次（2.47±0.56）次；碘缺乏程度：轻度16例、中度25例、重度17例。对照组年龄（28.53±2.08）岁；BMI（25.06±1.41）kg/m²；孕周（9.38±0.89）周；孕次（2.56±0.62）次；碘缺乏程度：轻度17例、中度28例、重度13例。对照组采用左甲状腺素口服，50 μg/次，1次/d。试验组在对照组基础上联合碘营养干预，轻、中度缺碘患者每日增加1份含150 μg碘的食物［4 g海苔（干）或4 g紫菜（干）或130 g海带（湿）］，重度缺碘患者每日增加2份含150 μg碘的食物。两组均连续治疗2个月。对比两组碘营养情况、甲状腺指标［促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT₃）、游离甲状腺素（FT₄）］、不良妊娠结局发生率。采用独立样本t检验、χ²检验、Ridit检验进行统计学分析。结果　治疗后，试验组碘营养情况优于对照组（P<0.05）。治疗后，试验组TSH水平低于对照组，FT₃、FT₄水平高于对照组（均P<0.05）。试验组胎儿生长受限发生率3.45%（2/58）、巨大儿发生率1.72%（1/58）、胎儿窘迫发生率1.72%（1/58），低于对照组的15.52%（9/58）、13.79%（8/58）、13.79%（8/58）（均P<0.05）。结论　碘营养干预联合左甲状腺素在妊娠期亚临床甲减患者中应用效果显著，能改善碘营养情况和甲状腺指标，减少不良妊娠结局的发生。

关键词:

甲状腺功能减退症, 妊娠期, 左甲状腺素, 碘营养

Abstract:

Objective　To study the clinical effect of iodine nutritional intervention combined with levothyroxine in patients with subclinical hypothyroidism during pregnancy. Methods　This study was a randomized controlled trial. A total of 116 patients with subclinical hypothyroidism in Zhengzhou Maternal and Child Health Hospital from January to December 2022 were selected and were divided into a control group (58 cases) and an experimental group (58 cases) according to the random number table method. The experimental group was (28.45±2.14) years old, the body mass index (BMI) was (25.15±1.32) kg/m², the gestational age was (9.41±0.92) weeks, the pregnancy times were 2.47±0.56, and there were 16 cases of mild iodine deficiency, 25 cases of moderate iodine deficiency, and 17 cases of severe iodine deficiency. The control group was (28.53±2.08) years old, the BMI was (25.06±1.41) kg/m², the gestational age was (9.38±0.89) weeks, the pregnancy times was 2.56±0.62, and there were 17 cases of mild iodine deficiency, 28 cases of moderate iodine deficiency, and 13 cases of severe iodine deficiency. The control group was given levothyroxine orally, 50 μg/time, once a day. The experimental group was given iodine nutritional intervention on the basis of the control group: the patients with mild and moderate iodine deficiency were additionally given 1 serving of food containing 150 μg of iodine [4 g of nori (dry) or 4 g of porphyra tenera (dry) or 130 g of kelp (wet)], and the patients with severe iodine deficiency were additionally given 2 serving of food containing 150 μg of iodine every day. Both groups were treated continuously for 2 months. The iodine nutrition, thyroid indices [thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4)], and incidence of adverse pregnancy outcomes were compared between the two groups. Independent sample t test, χ² test, and Ridit test were used for statistical analysis. Results　After treatment, the iodine nutrition of the experimental group was better than that of the control group (P<0.05). After treatment, the TSH level of the experimental group was lower than that of the control group, and the FT3 and FT4 levels were higher than those of the control group (all P<0.05). The incidence of fetal growth restriction in the experimental groups was 3.45% (2/58), the incidence of macrosomia was 1.72% (1/58), and the incidence of fetal distress was 1.72% (1/58), which were lower than those in the control group [15.52% (9/58), 13.79% (8/58), and 13.79% (8/58)] (all P<0.05). Conclusion　Iodine nutritional intervention combined with levothyroxine can improve the iodine nutrition and thyroid indices in patients with subclinical hypothyroidism during pregnancy, and reduce the occurrence of adverse pregnancy outcomes.

Key words:

Hypothyroidism, Pregnancy, Levothyroxine, Iodine nutrition

韩贝贝葛慧仙.

碘营养干预联合左甲状腺素在妊娠期亚临床甲状腺功能减退症患者中的应用效果 [J]. 国际医药卫生导报, 2025, 31(1): 38-41.

Han Beibei, Ge Huixian.

Effect of iodine nutritional intervention combined with levothyroxine in patients with subclinical hypothyroidism during pregnancy [J]. International Medicine and Health Guidance News, 2025, 31(1): 38-41.

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