摘要
目的对产后甲状腺炎(PPT)进行大样本的流行病学调查. 方法 610例辽宁省沈阳市产妇进入队列研究,488例(80%)随访6个月以上.进入队列的产妇均在分娩前、产后3个月和6个月时留取空腹血清,应用固相免疫化学发光酶免法测定血清TSH、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、游离T4(FT4)、游离T3(FT3)和甲状腺球蛋白(Tg),应用酶联免疫吸附法测定TSH受体抗体(TRAb).同时进行体格检查和甲状腺B超检查.产后6个月内血清TSH异常的产妇继续接受产后9个月和12个月的随访. 结果 488 例产妇中发现 58例PPT,患病率为 11.88%,其中临床 PPT 35例(7.17%),亚临床PPT 23例(4.71%);产后Graves病3例,患病率为0.62%.年龄、孕产次数和新生儿性别对PPT的患病率无显著影响.临床PPT患者中单纯甲亢型占45.7%,单纯甲减型占11.4%,甲亢甲减期双相型占42.9%,在产后12个月时仍有甲减者占8.6%;亚临床PPT 患者中单纯亚临床甲亢型占 65.2%,单纯亚临床甲减型占34.8%,无双相型表现.PPT患者的TPOAb阳性率显著高于非PPT产妇(P＜0.01);TPOAb阳性者PPT患病危险性显著高于TPOAb阴性者(RR=6.76,95%CI 4.42～10.34);患者在产后6个月时TPOAb 滴度达到高峰,临床PPT患者的TPOAb 滴度显著高于亚临床 PPT患者(P＜0.01).结论国内产妇临床PPT的患病率为7.17%,亚临床PPT的患病率为4.71%,约1/10的PPT患者在产后1年仍有甲状腺功能异常.甲状腺自身抗体TPOAb阳性是PPT发生的重要危险因素和预测指标,其滴度水平与疾病严重程度相关.
Objective To conduct an epidemiological survey on postpartum thyroiditis (PPT) in a large Chinese sample. Methods A total of 610 pregnant women from Shenyang, Liaoning Province were involved in the cohort study. Of them, 488 (80%) were followed up for more than 6 months after delivery. Fasting sera were collected just before delivery and 3, 6 months after delivery for the analyses of TSH, FT_ 3, FT_ 4, thyroglobulin (Tg), thyroid peroxidase antibody (TPOAb), TgAb and TSH receptor antibody (TRAb). Those diagnosed PPT were further observed 9 and 12 months after delivery. Results Fifty-eight of 488 women were diagnosed as PPT, and the prevalence of PPT was 11.88%. Among them overt and subclinical PPT were 35 cases (7.17%) and 23 cases (4.71%) respectively. Three postpartum women (0.62%) were diagnosed Graves′ disease. No significant correlations of the prevalence of PPT were found with pregnancy age, pregnancy frequency and fetus gender. Overt PPT patients had either thyrotoxicosis only or hypothyroidism only in 45.7% and 11.4% of cases respectively, and a classical course characterized by thyrotoxicosis at 3 months followed by hypothyroidism at 6 months of postpartum was seen in 42.9% of cases. 8.6% of patients remained hypothyroidism 1 year after delivery. Subclinical PPT patients had subclinical hyperthyroidism only (65.2%), subclinical hypothyroidism only (34.8%) and none of classical course. Positive rate of TPOAb in PPT cases was higher than that in normal pregnant women (P<0.01). Women with positive TPOAb had higher risk to develop PPT than those with negative TPOAb (RR=6.76, 95%CI 4.42-10.34). The titers of TPOAb rose to the peak 6 months after delivery, higher in overt cases than in subclinical cases (P<0.01). Conclusion The prevalence of overt and subclinical PPT are 7.17% and 4.71%, respectively. About one tenth of PPT cases remain thyroid dysfunction 1 year after delivery. Positive TPOAb is an important risk factor and a predictive marker of PPT. TPOAb level is related to the severity of PPT.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2005年第2期99-102,共4页
Chinese Journal of Endocrinology and Metabolism
基金
国家自然科学基金(30240013
30370680)
辽宁省科技计划项目基金 (2003225005 )
辽宁省教育厅课题基金(202013158)
