目的评估早孕妇女亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)对妊娠结局的影响及药物治疗的必要性。方法收集18 243例在厦门大学附属第一医院产前检查直至分娩的病例,诊断标准为妊娠10~12周产前检查时TT4与FT4正常而TSH≥2.5 m IU/L为SCH,甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)≥34 U/L为阳性。根据TSH的升高程度不同、TPOAb情况、能否遵医嘱按时按量服用L-T4使TSH控制在正常范围内进行分组:2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阳性且能遵医嘱者为A组,不能遵医嘱者为B组;TSH>5 m IU/L且TPOAb阳性且能遵医嘱者为C组,不能遵医嘱者为D组;2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阴性且能遵医嘱者为F组,不能遵医嘱者为G组;TSH>5 m IU/L且TPOAb阴性且能遵医嘱者为H组,不能遵医嘱者为K组。并随机抽取200例同期甲状腺功能正常的病例作为对照组(E组),回顾分析早孕妇女甲状腺功能异常的发生率、SCH对妊娠结局的影响、早孕妇女SCH行左旋甲状腺素片(L-T4)替代治疗的剂量及影响因素。结果早孕妇女SCH检出率为5.20%,甲状腺功能正常率为79.00%。A组早产3.31%(8/242)、妊娠期高血压7.02%(17/242)、胎儿生长受限7.02%(17/242)、出生低体质量儿6.61%(16/242)的发生率均低于B组的8.79%(8/91)、14.29%(13/91)、15.38(14/91)、14.29(13/91)(P均 5 m IU / L,TPOAb was positive and had good compliance; Group D: TSH and TPOAb as Group C but not have good compliance; Group F: 2. 5 m IU / L≤TSH≤5. 0 m IU / L,TPOAb was negative and had good compliance; Group G: as Group F,but not have good compliance; Group H: TSH > 5 m IU / L,TPOAb was negative and had good compliance; Group K: as Group H,but not have good compliance. Randomly selected 200 cases with normal thyroid function at the same period as the control group( Group E). Retrospective analysis the occurrence rate of thyroid gland dysfunction,the influence of SCH to pregnancy outcome,the doses and influencing factors of replacement therapy by L-T4 to SCH of early pregnant women. Results Relevance ratio of SCH in early pregnant women was5. 20%,the ratio of normal thyroid function was 79. 00%. In group A,premature birth 3. 31%( 8 /242),gestational hypertension 7. 02%( 17 /242),fetal growth restriction 7. 02%( 17 /242),low birth weight infant 6. 61%( 16 /242),were lower than that in group B 8. 79%( 8 /91),14. 29%( 13 /91),15. 38( 14 /91),14. 29( 13 /91) respectively( P < 0. 05). In group C,spontaneous abortion 3. 31%( 6 /181),premature birth 3. 89%( 7 /181),gestational hypertension 8. 29%( 15 /181),gestational diabetes mellitus 3. 89%( 7 /181),fetal growth restriction 7. 73%( 14 /181),low birth weight infant 6. 63%( 12 /181),were lower than that in group D 11. 54%( 6 /52),11. 54%( 6 /52),19. 23%( 10 /52),11. 54%( 6 /52),17. 31( 9 /52),15. 38( 8 /52)( P < 0. 05). No significant statistical difference were found in multiple comparison of the above six indexes of group A,B,C. And just the same as the multiple comparison of group F,G,H,K,E. When TSH reach the standard,the dosage of L-T4 in group A and C had significant difference [( 0. 757 ± 0. 378 vs. 1. 106 ± 0. 454) μg / kg,t = 8. 39,P < 0. 001]. There were also significant differences of group F compared with group H[( 0. 443 ± 0. 198 vs. 0. 813 ± 0. 378) μg/kg,t = 8. 22,P < 0. 001],group( A + F) compared with group( C + H) [( 0. 634 ± 0. 358 and 1. 017 ±0. 427) μg / kg,t = 11. 77,P < 0. 001],group A compared with group F [( 0. 757 ± 0. 378 vs. 0. 443 ± 0. 198) μg / kg,t = 9. 85,P < 0. 001 ],group C compared with group H [( 1. 106 ± 0. 45 vs. 0. 813 ± 0. 378) μg / kg,t = 5. 59,P < 0. 001],group( A + C) compared with group( F + H) [( 0. 932 ±0. 463 vs. 0. 693 ± 0. 388) μg / kg,t = 6. 53,P < 0. 001]. Conclusion The early pregnant women with SCH and TPOAb positive could increase the occurrence rate of spontaneous abortion,premature birth,gestational hypertension,gestational diabetes mellitus,fetal growth restriction and low birth weight infant. The early intervening treatment of L-T4 could efficiently decrease the adverse event occurrence ratio of pregnant woman with SCH and positive TPOAb,but no effect for that with SCH and TPOAb negative. The TSH level and condition of TPOAb could affect the replacement therapy dosage of early pregnancy with SCH
