本文關(guān)鍵詞： 妊娠 亞臨床甲狀腺功能減退癥 妊娠并發(fā)癥 產(chǎn)科結(jié)局 發(fā)育商 Gesell　出處：《蘭州大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:采用左甲狀腺素鈉片干預(yù)妊娠期亞臨床甲狀腺功能減退癥孕婦,觀察干預(yù)措施對(duì)妊娠并發(fā)癥、產(chǎn)科結(jié)局及其子代神經(jīng)智力發(fā)育的影響。方法:共納入研究對(duì)象46例,病例組21例,對(duì)照組25例。對(duì)照組不予特殊處理;病例組根據(jù)各自甲功給予適量L-T4,每4周檢測(cè)一次甲功,將各自甲功盡快調(diào)至目標(biāo)范圍內(nèi)。用調(diào)查問(wèn)卷的形式收集孕婦及其子代人口統(tǒng)計(jì)學(xué)資料,隨訪觀察孕婦妊娠并發(fā)癥、產(chǎn)科結(jié)局。隨訪孕婦子代2-3歲時(shí)甲功、Gesell量表。收集整理數(shù)據(jù),并統(tǒng)計(jì)分析。結(jié)果:1.病例組孕婦TSH水平高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(t=9.27,P=0.00)。病例組孕婦TPO-Ab陽(yáng)性者例6例(28.6%),對(duì)照組孕婦TPO-Ab陽(yáng)性者0例,二者陽(yáng)性率有統(tǒng)計(jì)學(xué)差異(Χ2=5.89,P=0.02)。2.孕婦子代2-3歲甲功異常,主要表現(xiàn)為FT3和TSH的升高。FT3升高25例,其中病例組子代11例,對(duì)照組子代14例,二者比較無(wú)統(tǒng)計(jì)學(xué)差異(Χ2=0.06,P=0.81)。TSH升高5例,其中病例組子代3例,對(duì)照組子代2例,二者比較無(wú)統(tǒng)計(jì)學(xué)差異(Χ2=0.04,P=0.84)。其中1例FT3與TSH同時(shí)升高,為病例組子代。3.孕婦妊娠并發(fā)癥及產(chǎn)科結(jié)局隨訪,病例組孕婦發(fā)現(xiàn)3例合并先兆流產(chǎn),占14.3%,2例合并貧血,占9.5%,對(duì)照組孕婦未發(fā)現(xiàn)先兆流產(chǎn)、貧血。病例組與對(duì)照組妊娠并發(fā)癥先兆流產(chǎn)、貧血發(fā)生率沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05)。分娩方式,病例組順產(chǎn)14例,占66.7%,剖宮產(chǎn)7例,占33.3%。對(duì)照組順產(chǎn)15例,占60%,剖宮產(chǎn)10例,占40%,兩組分娩方式無(wú)統(tǒng)計(jì)學(xué)差異(Χ2=0.22,P=0.64)。4.孕婦子代2-3歲神經(jīng)智力發(fā)育商異常,病例組發(fā)現(xiàn)6例,占28.6%,對(duì)照組發(fā)現(xiàn)5例,占20%,二者比較無(wú)統(tǒng)計(jì)學(xué)差異(Χ2=0.46,P=0.50)。兩組孕婦子代適應(yīng)性發(fā)育商、大運(yùn)動(dòng)發(fā)育商、精細(xì)運(yùn)動(dòng)發(fā)育商、語(yǔ)言發(fā)育商、個(gè)人-社交發(fā)育商五個(gè)方面均無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。以發(fā)育商低于85視為異常,兩組孕婦子代適應(yīng)性發(fā)育商、大運(yùn)動(dòng)發(fā)育商、精細(xì)運(yùn)動(dòng)發(fā)育商、語(yǔ)言發(fā)育商、個(gè)人-社交發(fā)育商五個(gè)方面異常者無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1.盡早對(duì)妊娠期亞甲減孕婦予以干預(yù),不僅有助于胎兒甲狀腺發(fā)育,還對(duì)其下丘腦-垂體-甲狀腺軸系建立正常反饋關(guān)系有益。2.盡早對(duì)妊娠期亞甲減孕婦予以干預(yù),可以明顯降低孕婦妊娠并發(fā)癥。3.盡早對(duì)妊娠期亞甲減孕婦予以干預(yù),有利于胎兒神經(jīng)系統(tǒng)發(fā)育和嬰幼兒階段神經(jīng)系統(tǒng)功能的完善。4.盡早篩查孕婦甲功并及早予以干預(yù)治療,對(duì)孕婦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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R714.256

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