孕期甲状腺功能异常及其抗体阳性流行病学调查

孕期甲状腺功能异常及其抗体阳性流行病学调查 孕期甲状腺功能异常及其抗体阳性流行病 学调查 [摘要] 目的 探讨妊娠期合并甲状腺功能异常和,或,其抗体阳性对妊娠结局的影响。 方法 回顾性2013年1月,2014年7月294例妊娠合并甲状腺功能异常和,或,其抗体阳性患者的妊娠结局及其影响。 结果 妊娠合并甲状腺功能异常可造成产妇不良分娩结局,孕妇TPOAb阳性的甲功异常与甲功正常者其产科并发症相比差异有统计学意义,χ2=9.512,P=0.002,,且孕期合并甲亢和甲减患者,比较治疗与未治疗组,差异有统计学意义,χ2=6.118,P=0.013,χ2=11.201,P=0.01,。 结论 做好孕前甲状腺功能的筛查,及时发现甲功异常并予以实施有效的治疗,可减少妊娠不良结局的发生 [关键词] 妊娠,甲状腺功能,甲状腺功能亢进,甲状腺功能减退 [中图分类号] R817.3 [文献标识码] B [文章编号] 1673-9701,2015,34-0100-04 Epidemiology investigation on abnormal thyroid function during pregnancy and its positive antibody QIN Ningning WANG Xiumei Department of Endocrinology, the Second People’s Hospital and Gynaecology and Obstetrics Hospital of Fuxin City in Liaoning Province, Fuxin 123000, China [Abstract] Objective To investigate the impact of pregnancy combined with thyroid dysfunction and ,or, its positive antibody on pregnancy outcomes. Methods A retrospective analysis was conducted on pregnancy outcomes and their influence in 294 cases of pregnant women with thyroid dysfunction and ,or, its positive antibody patients from January 2013 to July 2014. Results Pregnancy combined with thyroid dysfunction could cause maternal adverse birth outcomes, and the difference was statistically significant in comparing obstetric complications of TPOAb positive maternity with abnormal thyroid function and maternity with normal thyroid function ,χ2=9.512, P=0.002,. There was a significant difference in comparing obstetric complications of pregnancy combined with hyperthyroidism or hypothyroidism patients in the untreated group and the treated group ,χ2=6.118, P=0.013, χ2=11.201, P=0.01,. Conclusion Good preconception screening of thyroid function for timely detecting abnormal thyroid function and implementing effective treatment, can reduce the incidence of adverse pregnancy outcomes. [Key words] Pregnancy, Thyroid function, Hyperthyroidism, Hypothyroidism 在育龄妇女中,甲状腺疾病是较为常见的内分泌疾病,妊娠合并甲状腺功能,以下简称甲功,异常或甲状腺抗体阳性均可导致不良的妊娠结局,其主要的产科并发症为早产和流产,并且对母儿的危害影响较大。如果在孕前充分得到干预治疗,通常可以获得正常的妊娠结局。现收集2013年1月,2014年7月间在我院妇产科住院的294例妊娠合并甲状腺功能异常和,或,其抗体阳性患者的临床进行回顾性分析,探讨其对妊娠的影响,现报道如下 1 资料与方法 1.1 一般资料 2013年1月,2014年7月于我院妇产科住院治疗的8731例患者选取妊娠合并甲状腺功能异常和,或,其抗体阳性的患者594例,其中甲状腺功能正常TPOAb阳性患者300例,甲状腺功能异常TPOAb阳性患者294例,包括妊娠合并甲状腺功能亢进132例,及合并甲状腺功能减退162例。初产妇177例,经产妇117例,年龄20,40岁,3例为双胎妊娠,291例为单胎妊娠。根据妊娠期正规治疗与否 分为两组,妊娠期治疗中自行停药或未治疗者为对照组,治疗期间能适时调整药物剂量且定期复查甲功者为治疗组。妊娠合并甲亢者132例,其中亚临床甲亢129例,97.73%,,临床甲亢3例,2.27%,。妊娠合并甲减者162例,其中亚临床甲减54例,33.33%,,临床甲减108例,66.67%, 1.2 诊断 依据2011年美国甲状腺学会,ATA,颁布的《妊娠和产后甲状腺疾病诊断和处理》的标准做为诊断标准[1]。甲状腺功能亢进,TSH25 pmol/L,1.923 ng/dL,,亚临床甲亢,TSH2.5 uIU/mL,FT42.5 uIU/mL,而FT3和FT4水平在正常范围内。甲功正常TPOAb阳性,FT3、FT4、TSH水平在正常范围内,TPOAb>34 KU/L。产科并发症主要为流产和早产 1.3 研究方法 对我院2013年1月,2014年7月妇产科住院的妊娠合并甲状腺功能异常和,或,其抗体阳性的患者基本资料,包括患者年龄、症状、不良孕产史、实验室检查、孕期治疗、分娩及新生儿情况等,作回顾性分析 1.4 统计学分析 应用SPSS15.0统计学软件进行分析。应用[n,%,]表示计数资料,率的比较采用χ2检验,P 近年来有研究证实甲状腺自身抗体与妊娠期甲状腺功能减退、习惯性流产及产后甲状腺炎等疾病关系密切,妊娠早期,即孕12周, 甲状腺自身抗体阳性妇女与正常妊娠妇女相比,其流产率增加1倍。Pradhan等报道在妊娠早期,60%,70%的甲状腺过氧化物酶抗体,TPOAb,阳性的孕妇发生了产后甲状腺炎[14]。Lazarus等[15]的研究发现,约有50%妊娠期TPOAb阳性者出现产后甲状腺功能异常,在产后7年内,约有20%,30%的患者发展为永久性甲状腺功能减退。Glinoer等[16]研究发现,在孕前及妊娠早期,TPOAb阳性、甲功正常的妇女,有近20%妇女在妊娠时TSH>4 mIU/L,Negro等[17]进行的RCT研究证实,甲功正常,TPOAb阳性妇女,在妊娠过程中,TSH水平逐渐增高,在妊娠第12周平均增高,1.7,3.5,mlU/L,在分娩时TSH水平正常的仅有19%。Negro等[17]对甲功正常TPOAb阳性孕妇进行甲状腺素治疗,发现流产、早产的患病率降低,提示对甲功正常TPOAb阳性孕妇进行干预治疗是有效和必要的。本研究结果显示,妊娠期甲功正常TPOAb阳性新生儿窒息率为1.9%,表明对妊娠期TPOAb的重视也尤为重要 在育龄妇女中,甲状腺功能检查尚未在临床工作中做到全面普查,也未得到大家的重视,妊娠期及产后相关并发症发生较多,因此,为了降低妊娠期及产后相关并发症,对孕前及孕期仔细体检,并积极治疗甲状腺疾病,对孕产妇及新生儿至关重要。从本研究中分析得出,绝大多数的患者多为偏远山区及农村的孕产妇,常合并较为严重的并发症,以致 引起不良的妊娠结局。所以我们应在育龄妇女中普及甲状腺 的相关知识,让其对妊娠期甲状腺疾病及其并发症得到重 视,特别是偏远山区及农村的妇女,对其常规产检做到全面、 细致至关重要 [参考文献] [1] Stagnarogreen A,Abalovick M,Alexander E,et al. 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