2018 年第 9 期 第 13 卷

妊娠期亚临床甲状腺功能减退症后代的智力水平及其影响因素分析

Intelligence level and the influence factors in offsprings of subclinical hypothyroidism during pregnancy

作者：董香王琨王敏

英文作者：

单位：010010呼和浩特，内蒙古医科大学附属医院产科

英文单位：

关键词：甲状腺功能减退症；妊娠；智力

英文关键词：

• 摘要：

• 【摘要】目的    探讨妊娠期亚临床甲状腺功能减退症（甲减）后代的智力水平及其影响因素。方法    选取2009年3月至2012年8月在内蒙古医科大学附属医院进行产前检查并确诊为亚临床甲减的86例孕妇作为研究对象，其中接受海带、紫菜等含碘丰富的食物干预而未接受左甲状腺素钠片治疗40例（对照组）、接受左甲状腺素钠片治疗46例（观察组），比较2组孕妇干预前后的甲状腺功能及其后代智力水平，并对其后代智力水平的影响因素进行多因素Logistic回归分析。结果    2组孕妇基线临床资料比较差异均无统计学意义（均P>0.05）。干预前，2组孕妇的甲状腺功能比较差异均无统计学意义（均P>0.05）。干预后，观察组的促甲状腺激素水平显著低于对照组［(1.9±1.0)mU/L比(4.0±0.6)mU/L］，游离甲状腺素水平高于对照组［(16.5±2.0)pmol/L比(14.7±2.1)pmol/L］，差异均有统计学意义（均P<0.05）。出生1、3年后观察组孕妇后代的大运动发育商、精细动作发育商、适应性行为发育商、个人社交发育商以及语言发育商水平均高于对照组，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，母亲妊娠期促甲状腺激素水平、喂养方式、家庭月收入以及婴儿父母文化水平均对后代智力水平有影响（95%置信区间：1.073～40.286、1.572～8.885、1.068～3.774、1.701～8.315、1.633～8.273，均P<0.05）。结论    妊娠期亚临床甲减可影响后代的智力水平，而对亚临床甲减进行早期的规范治疗能明显改善其后代的智力水平。

• 【Abstract】Objective    To investigate the intelligence level of offsprings of subclinical hypothyroidism during pregnancy and to analyze the influence factors. Methods    A total of 86 pregnant women diagnosed of subclinical hypothyroidism were enrolled from March 2009 to August 2012 in the Affiliated Hospital of Inner Mongolia Medical University; 40 women had dietary therapy with food rich in iodine(control group); 46 women were treated with levothyroxine sodium tablets(observation group). Thyroid function was analyzed before and after treatment. Intelligence level of the offsprings was followed up. Influence factors of intelligence level were analyzed by multivariate Logistic regression. Results    Basic clinical data were similar between groups（P>0.05）. Before treatment, thyroid function indicators showed no significant differences between group（P>0.05）. After treatment, thyroid stimulating hormone(TSH) level in the observation group was significantly lower and free thyroxine level was significantly higher than those in the control group［(1.9±1.0)mU/L vs (4.0±0.6)mU/L, (16.5±2.0)pmol/L vs (14.7±2.1)pmol/L］（P<0.05）. In 1 year and 3 years old offsprings, gross motor quotient, fine motor quotient, adaptive behavior quotient, individual social behavior quotient and language quotient in the  observation group were significantly higher than those in the control group（P<0.05）. Multivariate Logistic regression analysis showed that maternal TSH level, feeding pattern, family monthly income and parents educational level had significant influence on the intelligence level （95% confidence interval： 1.073-40.286, 1.572-8.885, 1.068-3.774, 1.701-8.315, 1.633-8.273; P<0.05）. Conclusion    Subclinical hypothyroidism during pregnancy can affect the intelligence level of offspring.