JCEM:左旋甲状腺素对于甲状腺过氧化物酶抗体阴性的亚临床甲减孕妇有何影响?

2017-11-08 MedSci MedSci原创

大家都知道目前关于甲状腺过氧化物酶抗体阴性的亚临床甲减孕妇(SCH-TPOAb-)的甲状腺筛查和左旋甲状腺素(LT4)治疗尚未达成共识。而近日在JCEM上发表的一篇文章则评估了LT4对于SCH-TPOAb-妊娠结局的治疗效益。

大家都知道目前关于甲状腺过氧化物酶抗体阴性的亚临床甲减孕妇(SCH-TPOAb-)的甲状腺筛查和左旋甲状腺素(LT4)治疗尚未达成共识。而近日在JCEM上发表的一篇文章则评估了LT4对于SCH-TPOAb-妊娠结局的治疗效益。

Sima Nazarpour等人对SCH-TPOAb-孕妇进行了一项单盲随机临床试验,以促甲状腺激素(TSH)2.5mIU/L为切入点,纳入了366例SCH-TPOAb-和1092例甲功正常TPOAb-的妇女。SCH-TPOAb-的妇女被随机分为两组:A组(n=183)用LT4治疗而B组(n=183)不接受治疗。1028例甲功正常的SCH-TPOAb- 妇女作为对照组(C组)。研究的主要结果是早产率。

研究结果显示,以TSH2.5 mIU/L为切入点,A组和B组之间早产无显着差异(RR = 0.86,95%CI:0.47-1.55,P = 0.61)。然而,基于切点为4.0mIU/L的对数二项式模型分析显示与未接受治疗的妇女相比,LT4显着降低早产率(RR = 0.38,95%CI:0.15-0.98,P = 0.04)。

由上述研究可以发现,尽管以TSH2.5mIU/L为切点,LT4治疗对于减少SCH-TPOAb-妇女早产率没有效果,但如果以最新推荐的≥4.0mIU/L为切点,LT4可能减少这一并发症。

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    2018-08-27 smallant2015
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    2018-04-24 achengzhao
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