| 周娟,侯雯雯,朱烨,等.妊娠中期单纯性甲状腺自身抗体阳性及单纯性低甲状腺素血症对妊娠结局的影响[J].安徽医药,2018,22(11):2180-2183. |
| 妊娠中期单纯性甲状腺自身抗体阳性及单纯性低甲状腺素血症对妊娠结局的影响 |
| Effect of positive thyroid autoantibodies and simple hypothyroxinemia in the second trimester of pregnancy on pregnancy outcomes |
| 投稿时间：2017-07-30 |
| DOI： |
| 中文关键词: 妊娠中期 甲状腺过氧化物酶抗体 单纯性低甲状腺素血症 妊娠结局 妊娠并发症 |
| 英文关键词: Mid trimester of pregnancy Thyroid peroxidase antibody Simple hypothyroxinemia Pregnancy outcome Pregnancy complication |
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| 中文摘要: |
| 目的 分析甲状腺过氧化物酶抗体(TPOAb)在妊娠中晚期的患病率及滴度的变化特点,探讨妊娠中期单纯性TPOAb阳性和单纯性低甲状腺素(T4)血症对妊娠结局的影响。方法 选择2015年5月至10月在南京医科大学附属妇产医院产科产前门诊接受孕期检查的孕20～27周妊娠妇女2 300例,作为TPOAb阴性(-)组,用于制定妊娠中期甲状腺功能正常值的参考范围,其中甲状腺功能正常者2 075例,作为甲状腺功能正常组；妊娠中期TPOAb阳性孕妇167例,作为TPOAb阳性(+)组；采用化学发光免疫法分别于孕20～27周、孕30～34周及孕36～40周序贯检测孕妇血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、TPOAb,追踪记录孕期病情变化直至分娩。结果 妊娠中期FT4的参考值为9.82～16.77 pmol·L-1、TSH的参考值为0.60～4.88 mIU·L-1；TPOAb(+)组亚临床甲减发病率较TPOAb(-)组高(7.7% vs.2.48%,P＜0.05)；与孕20～27周组相比较,孕30～34周组和孕36～40周组TPOAb阳性发病率均明显下降(P＜0.01)；以孕20～27周组的111例TPOAb阳性者为观察对象,三个时期TPOAb滴度呈进行性下降；单纯性TPOAb(+)者149例,单纯性低甲状腺素(T4)血症者111例,单纯性TPOAb(+)组与甲状腺功能正常组比较,妊娠期糖尿病、妊娠期高血压疾病、胎膜早破、羊水异常、胎位异常、胎盘异常、脐带异常、妊娠丢失、早产、胎儿窘迫、新生儿窒息、胎儿发育异常、胎儿生长受限、巨大儿、有指征剖宫产、产后出血发病率均差异无统计学意义(P＞0.05),单纯性低T4组与甲状腺功能正常组比较,妊娠期糖尿病、巨大儿发病率及有指征剖宫产发生率明显升高(分别为P＜0.01、P＜0.05、P＜0.01),余各指标比较均差异无统计学意义(P＞0.05)。 结论 TPOAb阳性率及滴度随孕周增加均呈逐渐下降趋势,妊娠中期单纯性TPOAb阳性不增加不良妊娠结局及并发症的发生率,单纯性低T4血症与妊娠期糖尿病、巨大儿发病率及有指征剖宫产发生率升高有关。 |
| 英文摘要: |
| Objective To analyze the incidence rates and titer changes of thyroid peroxidase antibody (TPOAb) in the second and third trimester of pregnancy,and to discuss the effect of simple positive TPOAb and simple hypothyroxinemia in the second trimester of pregnancy on pregnancy outcome.Methods A total of 2300 pregnant women who were examined at their 20th to 27th gestation week in Antenatal Clinic of Obstetrics Department,Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from May to October 2015 were selected as negative TPOAb group to generate the euthyroid reference range of serum thyroid function in the mid trimester of pregnancy.Among them,2 075 women with normal thyroid function were named normal thyroid function group.A hundred and sixty-seven women with positive TPOAb in the second trimester of pregnancy were named positive TPOAb group.The serum levels of thyroid stimulating hormone (TSH),free thyroxine (FT4) and TPOAb of pregnant women were detected by chemiluminescence immunoassay method in three stages,which were 20th to 27th gestational week,30th to 34th gestational week and 36th to 40th gestational week.Their condition changes during pregnancy until delivery were traced and recorded.Results The euthyroid reference ranges of serum FT4 and TSH in the mid trimester of pregnancy were 9.82 to 16.77 pmol·L-1 and 0.60 to 4.88 mIU·L-1,respectively.The morbidity of subclinical hypothyroidism in positive TPOAb group was higher than that in negative TPOAb group (7.7% vs.2.48%,P＜0.05).The incidence rates of positive TPOAb in 30th to 34th gestational week and 36th to 40th gestational week were significantly lower than that in 20th to 27th gestational week (P＜0.01).A hundred and eleven cases of pregnant women with positive TPOAb in their 20th to 27th gestational week were observed continuously,the titer of TPOAb decreased progressively in three periods.There were 149 cases of simple positive thyroid autoantibody,and 111 cases of simple hypothyroxinemia.Compared with normal thyroid function group,the differences of the incidence rates of gestational diabetes and hypertension disorders complicating pregnancy,as well as premature rupture of membrane,amniotic fluid abnormality,abnormal fetal position,placenta abnormality,umbilical cord abnormality,pregnancy loss,preterm birth,fetal distress,neonatal asphyxia,fetal dysplasia,fetal growth restriction,macrosomia,cesarean section with indications and postpartum hemorrhage in simple positive TPOAb group were not statistically significant (P＞0.05).Compared with normal thyroid function group,the incidence rates of gestational diabetes and macrosomia as well as cesarean section with indications in simple hypothyroxinemia group were increased significantly (P＜0.01,P＜0.05 and P＜0.01,respectively),and the other indexes had no significant differences (P＞0.05).Conclusion The rate of positive TPOAb and the titer of TPOAb decreased with the increase of gestational week.In the mid trimester of pregnancy simple positive TPOAb did not increase the incidence rates of adverse pregnancy outcomes and complications.The simple hypothyroxinemia was related to the increased incidence rates of gestational diabetes,macrosomia and cesarean section with indications. |
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