| 251 | 8 | 28 |
| 下载次数 | 被引频次 | 阅读次数 |
亚临床甲状腺功能减退(甲减)是妊娠期常见的内分泌疾病,可能增加不良妊娠结局发生风险和危害子代发育,但目前对患有亚临床甲减的妊娠期妇女进行左旋甲状腺素药物干预能否消除亚临床甲减带来的健康损害,目前尚存争议,并且何种情况启动药物治疗、药物剂量如何调整,意见仍不一致。因此,有待更多科学严谨的大样本前瞻性研究结果,来不断补充临床证据,进一步细化妊娠期亚临床甲减的左旋甲状腺素治疗方案。
Abstract：Subclinical hypothyroidism is a common endocrine disease during pregnancy. It may increase the risk of adverse pregnancy outcome and dysplasia of the offspring. However,It is still controversial whether the diagnosis of subclinical hypothyroidism during pregnancy should be treated with levothyroxine. Moreover,what kind of circumstances need to start drug treatment,how to adjust the drug dose,there is still disagreement. Therefore,more scientific and rigorous and large sample of research results are needed to clinical practice and accurate treatment of subclinical hypothyroidism with levothyroxine.
[1]中华医学会内分泌学分会．成人甲状腺功能减退症诊治指南[J]．中华内分泌代谢杂志，2017,33(2):167-180. DOI:10. 3760/cma. j. issn. 1000-6699. 2017.02. 018.
[2] Gowachirapant S,Melse-Boonstra A,Winichagoon R,et al. Overweight increases risk of first trimester hypothyroxinaemia in iodine-deficient pregnant women[J]. Matern Child Nutr,2014,10(1):61-71. DOI:10. 1111/mcn. 12040.
[3] Lazarus J,Brown RS,Daumerie C,et a1. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children[J]. Eur Thyroid J,2014,3(2):76-94. DOI:10.1159/000362597.
[4]于晓会．妊娠期甲状腺疾病的流行病学研究[D]．中国医科大学，2008.
[5] Hollowell JG Jr,Garbe PL,Miller DT. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child[J]. N Engl J Med,1999,341(26):2016-2017.
[6] Haddow JE,Palomaki GE,Allan WC,et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child[J]. N Engl J Med,1999,341(8):549-55. DOI:10. 1056/NEJM199908193410801
[7] Su PY,Huang K,Hao JH,et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development:a prospective population-based cohort study in China[J]. J Clin Endocrinol Metab,2011,96(10):3234-3241. DOI:10. 1210/jc. 2011-0274.
[8] Cleary-Goldman J,Malone FD,Lambert-Messerlian G,et al. Maternal thyroid hypofunction and pregnancy outcome[J]. Obstet Gynecol,2008,112(1):85-92. DOI:10. 1097/AOG. 0b013e3181788dd7.
[9] Thangaratinam S,Tan A,Knox E,et al. Association between thyroid autoantibodies and miscarriage and preterm birth:meta-analysis of evidence[J]. BMJ,2011,9(5):342:d2616. DOI:10. 1136/bmj. d2616.
[10] Liu H,Shan Z,Li C,et al. Maternal subclinical hypothyroidism,thyroid autoimmunity,and the risk of miscarriage:a prospective cohort study[J]. Thyroid,2014,24(11):1642-1649. DOI:10. 1089/thy. 2014. 0029.
[11]刘玉芳，张晓梅，柴三葆，等．妊娠期亚临床甲状腺功能减退症对妊娠结局和后代的影响[J]．中华内分泌代谢杂志，2017,33(3):269-272. DOI:10. 3760/cma. j. issn. 1000-6699. 2017. 03. 021
[12] Biondi B,Bartalena L,Chiovato L,et al. Recommendations for treatment of hypothyroidism with levothyroxine and levotriiodothyronine:a 2016 position statement of the Italian Society of Endocrinology and the Italian Thyroid Association[J]. J Endocrinol Invest,2016,39(12):1465-1474.
[13] Tariq A,Wert Y,Cheriyath P,et al. Effects of LongTerm Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life[J]. South Med J,2018,111(6):363-369. doi:10. 14423/SMJ. 0000000000000823.
[14] Hennessey JV,Espaillat R. Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy[J]. Int J Clin Pract,2018,72(2). doi:10. 1111/ijcp. 13062.
[15] Jonklaas J,Bianco AC,Bauer AJ,et al. Guidelines for the treatment of hypothyroidism:prepared by the American thyroid association task force on thyroid hormone replacement[J]. Thyroid,2014,24(12):1670-1751.
[16] Stagnaro-Green A,Abalovich M,Alexander E,et al.American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J]. Thyroid,2011,21(10):1081-125.DOI:10. 1089/thy. 2011. 0087.
[17]中华医学会内分泌学分会，中华医学会围产医学分会．妊娠和产后甲状腺疾病诊治指南[J]．中华内分泌代谢杂志，2012,28(5):354-371. DOI:10. 3760/cma. j. issn. 1000-6699. 2012. 05. 002.
[18] Committee on Patient Safety and Quality Improvement;Committee on Professional Liability. ACOG Committee Opinion No. 381:Subclinical hypothyroidism in pregnancy[J]. Obstet Gynecol,2007,110(4):959-960.
[19] Garber JR,Cobin RH,Gharib H,et al. Clinical practice guidelines for hypothyroidism in adults:cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association[J]. Endocr Pract,2012,18(6):988-1028.
[20] De Groot L,Abalovich M,Alexander EK,et al. Management of thyroid dysfunction during pregnancy and postpartum:an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab,2012,97(8):2543-2565. DOI:10. 1210/jc. 2011-2803.
[21] Alexander EK,Pearce EN,Brent GA,et al. 2017Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J]. Thyroid,2017,27(3):315–389.
[22] Gao X,Li Y,Li J,et al. Gestational TSH and FT4Reference Intervals in Chinese Women:A Systematic Review and Meta-Analysis[J]. Front Endocrinol(Lausanne), 2018, 9:432. doi:10. 3389/fendo.2018. 00432.
[23]中华医学会内分泌学分会，中华医学会围产医学分会．妊娠和产后甲状腺疾病诊治指南．2版[J]．中华内分泌代谢杂志，2019,35(8):636-665.
[24] British Thyroid Association. UK guidelines for the use of thyroid function tests[J]. Journal Asian Earth Sciences,2006,20(5):459-479. DOI:10. 1016/S1367-9120(01)00039-6
[25] Brenta G1,Vaisman M,Sgarbi JA,et al. Clinical practice guidelines for the management of hypothyroidism[J]. Arq Bras Endocrinol Metabol,2013,57(4):265-91.
[26] Yu X,Chen Y,Shan Z,et al. The pattern of thyroid function of subclinical hypothyroid women with levothyroxine treatment during pregnancy[J]. Endocrine,2013,44(3):710-715. DOI:10. 1007/s12020-013-9913-2.
[27] Abalovich M,Vázquez A,Alcaraz G,et al. Adequate levothyroxine doses for the treatment of hypothyroidism newly discovered during pregnancy[J]. Thyroid,2013,23(11):1479-83. DOI:10. 1089/thy. 2013. 0024.
[28] Sullivan SD,Downs E,Popoveniuc G,et al. Randomized Trial Comparing Two Algorithms for Levothyroxine Dose Adjustment in Pregnant Women With Primary Hypothyroidism[J]. J Clin Endocrinol Metab,2017,102(9):3499-3507. DOI:10. 1210/jc. 2017-01086.
[29] Maraka S,Singh Ospina NM,O’Keeffe DT,et al.Effects of increasing levothyroxine on pregnancy outcomes in women with uncontrolled hypothyroidism[J].Clin Endocrinol(Oxf),2017,86(1):150-155. DOI:10. 1111/cen. 13168.
[30] Zhang L,Zhang Z,Ye H,et al. Association between the clinical classification of hypothyroidism and reduced TSH in LT4 supplemental replacement treatment for pregnancy in China[J]. Gynecol Endocrinol,2016,32(5):374-8. DOI:10. 3109/09513590. 2015. 1121228.
[31]刘晓兰，陈瑞芳，蔡芸．左甲状腺素钠顿服和分次服治疗妊娠期亚临床甲减的临床疗效比较[J]．医学信息，2016,29(5):332.
[32]陈国芳，刘超．2017亚临床甲减疾病的新挑战:从指南到实践[J]．中华内分泌代谢杂志，2017,33(1):88-90. DOI:10. 3760/cma. j. issn. 1000-6699. 2017.01. 017.
[33]杨俊娟，郭华峰，丁书贵，等．孕早期合并亚甲减及其中TPOAb阳性孕妇治疗与否对围产结局的影响[J]．中华妇产科杂志，2015,50(9):652-657. DOI:10. 3760/cma. j. issn. 0529-567X. 2015. 09. 003
[34] Ju R,Lin L,Long Y,et al. Clinical efficacy of therapeutic intervention for subclinical hypothyroidism during pregnancy[J]. Genet Mol Res,2016,15(4). DOI:10.4238/gmr15049019.
[35] Maraka S,Singh Ospina NM,O’Keeffe DT,et al.Effects of Levothyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism[J]. Thyroid,2016,26(7):980-986. DOI:10. 1089/thy. 2016.0014.
[36] Nazarpour S,Ramezani Tehrani F,Simbar M,et al.Effects of Levothyroxine on Pregnant Women With Subclinical Hypothyroidism,Negative for Thyroid Peroxidase Antibodies[J]. J Clin Endocrinol Metab,2018,103(3):926-935. DOI:10. 1210/jc. 2017-01850.
[37]吴跃跃，陈琳，黄新梅，等．妊娠期亚临床甲状腺功能减退的临床分析及甲状腺激素替代治疗的效果观察[J]．中华内分泌代谢杂志，2017,33(3):198-202. DOI:10. 3760/cma. j. issn. 1000-6699. 2017.03. 005.
[38] Wang H,Gao H,Chi H,et al. Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer:A Randomized Clinical Trial[J]. JAMA,2017,318(22):2190-2198. DOI:10. 1001/jama. 2017. 18249.
[39] 2018中国居民补碘指南．中国卫生健康委员会官网．
[40]张爽，李楠，李薇，等．孕产期碘营养对妊娠期亚临床甲减女性产后甲状腺功能的影响[J]．中华内分泌代谢杂志，2019,35(7):570-575.
[41] Gartner R,Gasnier BC,Dietrich JW,et al. Selenium supplementation in patients with autoimmune thyoiditis decreases thyroid peroxidase antibodies concentrations[J]. J Clin Endocrinol Metab,2002,87(4):1687-1691.
[42] Duntas LH,Mantzou E,Koutras DA. Effects of a six month treatment with selenomethionine in patients with autoimmune thyroiditis[J]. Eur J Endocrinol,2003,148(4):389-393.
[43]张爽，李楠，李卫芹，等．妊娠前半期孕妇碘硒营养状况和亚临床甲状腺功能减退及甲状腺抗体的关系[J]．中华内分泌代谢杂志，2018,34(1):38-43.
基本信息:
DOI：10.19757/j.cnki.issn1674-7763.2020.02.020
中图分类号:R714.256
引用信息:
[1]张爽,冷俊宏.妊娠期亚临床甲状腺功能减退应用左旋甲状腺素干预治疗的研究进展[J].中国妇幼卫生杂志,2020,11(02):76-82.DOI:10.19757/j.cnki.issn1674-7763.2020.02.020.
基金信息:
天津市卫生行业重点攻关项目(15KG118);; 中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目(2019FYH012)