评估不同剂量左甲状腺素钠（LT4）在妊娠早期 TSH 水平偏高和 TPOAb 阳性的孕妇中的治疗效果。
Evaluation of the therapeutic efficacy of different doses of LT4 in pregnant women with high-normal TSH levels and TPOAb positivity in the first half of pregnancy.
机构信息
Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
出版信息
Lipids Health Dis. 2024 Apr 10;23(1):101. doi: 10.1186/s12944-024-02099-9.
BACKGROUND
The objective was to investigate the efficacy of different doses of levothyroxine therapy among pregnant women exhibiting high-normal thyroid stimulating hormone levels and positive thyroid peroxidase antibodies throughout the first half of pregnancy.
METHODS
Pregnant women exhibiting high-normal thyroid stimulating hormone levels and thyroid peroxidase antibodies positivity throughout the initial half of pregnancy were selected from January 2021 to September 2023. Based on the different doses of levothyroxine, the pregnant women were categorized into the nonintervention group (G, 122 women), 25 µg levothyroxine intervention group (G, 69 women), and 50 µg levothyroxine intervention group (G, 58 women). Serum parameters, gastrointestinal symptoms, small intestinal bacterial overgrowth (SIBO), maternal and neonatal outcomes were compared after the intervention among the three groups.
RESULTS
After the intervention, in the G and G groups, the thyroid stimulating hormone, triglyceride and low-density lipoprotein levels were notably less in contrast to those in the G group (P < 0.05). The rates of abdominal distension and SIBO in the G and G groups were notably lower in contrast to the G group (P = 0.043 and 0.040, respectively). The G group had a lower rate of spontaneous abortion and premature membrane rupture than the G group (P = 0.01 and 0.015, respectively). Before 11 weeks of gestation and at thyroid peroxidase antibodies levels ≥ 117 IU/mL, in contrast to the G group, the G group experienced a decreased rate of spontaneous abortion (P = 0.008). The G group had significantly higher newborn weight than the G group (P = 0.014), as well as a notably longer newborn length than the G and G groups (P = 0.005).
CONCLUSIONS
For pregnant women with high-normal thyroid stimulating hormone levels and thyroid peroxidase antibodies positive during the first half of pregnancy, supplementation with 50 µg levothyroxine was more effective in improving their blood lipid status and gastrointestinal symptoms, reducing the incidence of SIBO and premature rupture of membranes, and before 11 weeks, TPOAb ≥ 117 IU/mL proved more beneficial in mitigating the risk of spontaneous abortion.
背景
本研究旨在探讨妊娠前半期甲状腺刺激激素水平偏高和甲状腺过氧化物酶抗体阳性的孕妇接受不同剂量左甲状腺素治疗的疗效。
方法
选取 2021 年 1 月至 2023 年 9 月期间妊娠前半期甲状腺刺激激素水平偏高和甲状腺过氧化物酶抗体阳性的孕妇。根据左甲状腺素的不同剂量，将孕妇分为非干预组（G 组，122 例）、25μg 左甲状腺素干预组（G 组，69 例）和 50μg 左甲状腺素干预组（G 组，58 例）。比较三组干预后血清学参数、胃肠道症状、小肠细菌过度生长（SIBO）、母婴结局。
结果
干预后，G 组和 G 组的甲状腺刺激激素、甘油三酯和低密度脂蛋白水平明显低于 G 组（P<0.05）。G 组和 G 组腹胀和 SIBO 的发生率明显低于 G 组（P=0.043 和 0.040）。G 组自发性流产和胎膜早破的发生率明显低于 G 组（P=0.01 和 0.015）。在妊娠 11 周前和甲状腺过氧化物酶抗体水平≥117IU/mL时，与 G 组相比，G 组自发性流产的发生率降低（P=0.008）。G 组新生儿体重明显高于 G 组（P=0.014），新生儿长度明显长于 G 组和 G 组（P=0.005）。
结论
对于妊娠前半期甲状腺刺激激素水平偏高和甲状腺过氧化物酶抗体阳性的孕妇，补充 50μg 左甲状腺素更能改善血脂状况和胃肠道症状，降低 SIBO 和胎膜早破的发生率，在妊娠 11 周前和 TPOAb≥117IU/mL 时，能更有效地降低自发性流产的风险。
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