摘要
目的探讨甲状腺功能亢进（甲亢）患者孕前及妊娠期治疗是否能减少妊娠并发症、降低胎儿丢失率及改善母婴结局。方法回顾性分析我院1995年1月至2005年12月共11年间60例妊娠合并甲亢患者孕前及妊娠期治疗及母婴结局。60例患者分为三组：甲亢病史组（Ⅰ组）：19例有甲亢病史，孕期监测甲状腺功能未复发组；治疗满意组（Ⅱ组）：28例曾应用抗甲状腺药物治疗，终止妊娠时甲状腺功能正常；治疗不满意组（Ⅲ组）：13例孕期未系统治疗，就诊时间晚、病情重，终止妊娠时甲状腺功能异常。结果（1）妊娠合并甲亢进入围产期的发病率为2．25‰（52／23104），因病情严重28周前终止妊娠8例，胎儿丢失率为11．8％（8／60）；（2）Ⅰ组无妊娠并发症发生；（3）Ⅲ组与Ⅱ组相比，重度子痴前期（53．9％和10．7％）、甲亢性心脏病（38．5％和3．6％）、胎盘早剥（23．1％和3．6％）的发生率和胎儿丢失率（46．2％和7．1％）均有显著增加（P〈O．05）；（4）Ⅲ组与Ⅱ组相比，并发重度子痫前期的OR=9．72（95％CI：1.53-71．21）、甲亢性心脏病OR=16．88（95％CI：1．45-826．42）、胎盘早剥OR=8．1（95％CI：0．54-440．44）、胎儿丢失OR=11．14（95％CI：1．45-126．39）；（5）Ⅲ组新生儿平均体重明显低于Ⅱ组和Ⅰ组[（2550±573）g和（3211士717）g、（3186士492）g，P〈O．05]；（6）Ⅲ组中有一例新生儿发生甲状腺功能减退；三组均无孕妇及围产儿死亡、无新生儿畸形。结论重视甲亢的孕前及孕期治疗，能有效降低孕期并发症、减少胎儿丢失率及改善围产期母儿结局。
Objective To investigate whether the treatment in pregestational and gestational period can reduce the pregnant complications and the rate of fetal loss and improve the maternal and fetal outcomes in women with hyperthyoidism. Methods A retrospective study was conducted on 60 pregnant women with hyperthyroidism in the First Hospital of Peking University from Jan. 1995 to Dec. 2005. The therapy in pregestation and gestation period and the rate of fetal loss were analyzed. All women were divided into 3 groups： 19 women with hyperthyroidism history and without recur-rence during the indicated pregnancy（group I ） ; 28 well treated cases who had received antithyroids during pregestation and gestation period and resulted euthyroidism at the end of the pregnancy（group II ） ; 13 unwell treated women who did not receive treatments, presented late to the clinics with severe conditions and resulted thyroid dysfunction at the end of the pregnancy （group Ⅲ ）. Results The prevalence of pregnancy complicated with hyperthyroidism was 2.25‰ （52/23 104）. Eight cases were in severe conditions and had to terminate the pregnancy giving the fetal loss rate of 11.8 % （8/60）. No complication was reported in group I. Increased rates of severe pre-eclampsia（53.9% vs 10.7%）, cardiac disease induced by hyperthyroidism（38. 5% vs 3.6%）, placental abruption（23. 0% vs 3.6%） and fetal loss （46.2% vs 7. 1%） were found in group Ⅲ than in Group Ⅱ （P〈0.05）. Comparing with Group Ⅱ , the OR values of severe pre-eclampsia, cardiac disease induced by hyperthyroidism, placental abruption and loss of fetus in group Ⅲ were 9.72（95 %CI： 1.53-71.21）, 16.88（95 %CI： 1.45- 826.42）, 8.1 （95 % CI： 0.54-440. 44） and 11.14 （ 95 % CI： 1.45-126.39）. The mean neonatal birth weight in Group Ⅲ was significantly lower than that in group Ⅱ and I [（2550±573）g vs （3211±717）g and （3186±492）g, P〈0. 05]. No maternal and perinatal death and neonatal malformation was reported am
出处
《中华围产医学杂志》
CAS
2007年第6期378-382,共5页
Chinese Journal of Perinatal Medicine
