丙基硫氧嘧啶與甲巰咪唑治療妊娠合并甲亢的效果及對(duì)母嬰結(jié)局的影響

張昌鳳 周雪梅 官葵花

【摘要】 目的：研究丙基硫氧嘧啶（PTU）與甲巰咪唑（MMI）治療妊娠合并甲亢的效果及對(duì)母嬰結(jié)局的影響。方法：選取2015年1月-2018年1月筆者所在醫(yī)院收治的妊娠合并甲亢患者86例作為研究對(duì)象，運(yùn)用隨機(jī)數(shù)表法將所有研究對(duì)象隨機(jī)分成A組和B組，每組43例。A組確診后口服PTU治療，B組確診后服用MMI治療，觀察兩組病情變化，統(tǒng)計(jì)分析兩組母嬰結(jié)局。結(jié)果：治療后，兩組患者甲狀腺功能各項(xiàng)指標(biāo)（TT4、TT3、FT4、FT3、TSH）對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;治療后，A組孕產(chǎn)婦不良妊娠結(jié)局發(fā)生率（23.25%）明顯高于B組（6.98%），差異有統(tǒng)計(jì)學(xué)意義（P<0.05），A組新生兒不良結(jié)局發(fā)生率（4.65%）明顯低于B組（18.60%），差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論： PTU和MMI治療妊娠合并甲亢均取得良好治療效果，很大程度上優(yōu)化了孕婦甲狀腺功能，改善母嬰結(jié)局。但PTU對(duì)孕產(chǎn)婦產(chǎn)生的不良影響更大，MMI對(duì)胎兒發(fā)育影響較大，但兩種藥物大多數(shù)為輕微不良反應(yīng)。綜合衡量，MMI可作為優(yōu)先治療妊娠合并甲亢的藥物，值得臨床借鑒。

【關(guān)鍵詞】 甲巰咪唑; 妊娠; 甲亢; 母嬰結(jié)局

doi：10.14033/j.cnki.cfmr.2019.15.018 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805（2019）15-00-03

【Abstract】 Objective：To study the effect of Propylthiouracil（PTU） and Methimazole（MMI） on pregnant women with hyperthyroidism and their maternal and infant outcomes.Method：A total of 86 pregnancy complicated with hyperthyroidism were selected from January 2015 to January 2018.All the subjects were randomly divided into group A and group B with 43 cases in each group.The patients in group A were treated with PTU orally and the patients in group B were treated with MMI after diagnosis.The changes of the two groups were observed，and the outcomes of mothers and infants in two groups were analyzed statistically.Result：After treatment，there was no significant difference in thyroid function indexes（TT4，TT3，F(xiàn)T4，F(xiàn)T3，TSH） between the two groups（P>005）.The incidence of adverse pregnancy outcome was 23.25%，significantly higher than 6.98% in group B （P<0.05）.The incidence of adverse outcome in group A was 4.65%，significantly lower than 18.60% in group B（P<0.05）.Conclusion：PTU and MMI in the treatment of pregnancy with hyperthyroidism achieved good results，greatly optimized the thyroid function of pregnant women，improve maternal and infant outcomes.But the negative impact of PTU on pregnant women is even greater，and the influence of the MMI on the development of the fetus is large，but the two drugs are mostly mild bad reaction.Comprehensive measurement，MMI can be used as a priority treatment of pregnancy with hyperthyroidism drugs，worthy of clinical reference.

【Key words】 Methimazole; Pregnancy; Hyperthyroidism; Maternal and infant outcome

正常水平的甲狀腺功能是胎兒神經(jīng)、智力發(fā)育的重要條件，甲亢是指多種原因?qū)е录谞钕偌に胤置谶^(guò)多引起的甲狀腺功能亢進(jìn)[1]。妊娠合并甲亢屬于高危妊娠的一種，其包括了妊娠之前已確診甲亢及妊娠期并發(fā)甲亢者[2]。有資料指出，妊娠合并甲亢的發(fā)病率為0.1%～0.2%[3]，該病若未經(jīng)系統(tǒng)有效治療，很有可能引起多種不良母嬰結(jié)局，例如孕婦妊娠高血壓、甲狀腺危象、心力衰竭，以及胎兒畸形、流產(chǎn)、早產(chǎn)、低體重等不良母嬰結(jié)局，對(duì)孕產(chǎn)婦及新生兒的健康造成了嚴(yán)重的威脅[4]，目前臨床上對(duì)于妊娠合并甲亢首選治療方式為抗甲狀腺藥物治療，有研究指出PTU、MMI作為兩種常用的抗甲狀腺藥物，治療效果顯著，均能夠有效減少妊娠期并發(fā)癥，降低胎兒損害，但有關(guān)這兩種藥物孰優(yōu)孰劣頗具爭(zhēng)議[5]。所以，本研究主要觀察了PTU與MMI治療妊娠合并甲亢的效果及對(duì)母嬰結(jié)局的影響，研究結(jié)果報(bào)告如下。