摘要
目的探讨妊娠晚期妇女甲状腺疾病的患病率、患病特点和甲状腺自身抗体的变化。方法选择664例妊娠晚期妇女为妊娠组,276例非妊娠育龄妇女作为对照组。应用固相化学发光酶免疫法测定两组妇女的血清促甲状腺激素(TSH)和抗甲状腺过氧化物酶抗体(TPOAb)水平;TSH水平检测异常者加测游离甲状腺素(FT4)和游离三碘甲状腺原氨酸(FT3),同时测定尿碘水平。按如下标准确定诊断:TSH<0．3 mU／L,FT4和(或)FT3水平升高者诊断为临床甲状腺功能亢进症(甲亢);TSH<0．3 mU／L,而FT4和FT3水平正常者诊断为亚临床甲亢;TSH>4．8 mU／L,FT4水平降低者诊断为临床甲状腺功能减退症(甲减);TSH>4．8 mU／L,而FT4和FT3水平正常者诊断为亚临床甲减。TPOAb>5 kU／L为阳性。结果(1)妊娠组妇女尿碘平均水平为201．5μg／L,对照组妇女尿碘平均水平为196．0μg／L,均为碘充足水平。两组比较,差异无统计学意义(P>0．05)。(2)妊娠组妇女甲状腺疾病总患病率为7．8％(52／664),对照组妇女甲状腺疾病总患病率为6．9％(19／276)。两组比较,差异无统计学意义(P>0．05)。(3)两组妇女的甲状腺患病类型有明显不同,妊娠组妇女甲亢患病率为1．1％(7／664),甲减患病率为6．8％(45／664),妊娠组妇女甲亢患病率明显低于甲减,两者比较,差异有统计学意义(P<0．01);对照组甲亢患病率为4．7％(13／276),甲减患病率为2．2％(6／276),两者比较,差异无统计学意义(P>0．05)。妊娠组与对照组妇女的甲亢或甲减患病率分别比较,差异均有统计学意义(P<0．01)。(4)妊娠组非患病妇女的TSH水平显著高于对照组,分别为2．50 mU／L及1．54 mU／L,差异有统计学意义(P<0．01);妊娠组妇女TPOAh阳性率显著低于对照组,分别为3．3％(22／664)及9．4％(26／276),差异有统计学意义(P<0．01)。结论妊娠晚期妇女甲状腺疾病的特点是甲减的患病率高,同时甲状腺自身免疫功能受到抑制。
Objective To study the prevalence of thyroid diseases, as well as characteristics of the disease spectrum and thyroid autoimmunity in women at the end of pregnancy. Methods Six hundred and sixty-four pregnant women （pregnancy group） and 276 non-pregnant women （control group） were enrolled in the study. Serum thyrotropin（TSH）, thyroid peroxidase antibody （TPOAb） , free T3 （FT3 ） and free T4 （FT4 ） were measured by high-sensitive immunochemiluminescent assay, and urinary iodine was also examined at the end of pregnancy. Overt hyperthyroidism was diagnosed when both TSH 〈 0. 3 mU/L and FT4 and/or FT3 levels were elevated. Subclinical hyperthyroidism was diagnosed when TSH 〈 0. 3 mU/L with normal FT4 and FT3 levels. The diagnostic criteria for overt hypothyroidism was TSH 〉 4. 8 mU/L accompanied by decreased FT4, and for subclinical hypothyroidism was TSH 〉 4. 8 mU/L with normal FT4 and FT3 levels. Results （ 1 ） The median urinary iodine （MUI） of pregnancy group was 201.5 μg/L, and that of control group was 196. 0 μg/L （P 〉0. 05）. Women in the two groups were iodine-adequate. （2） The overall prevalence of thyroid diseases in pregnancy group and control group was 7.8% （52/664） and 6. 9% （19/276） , respectively （P 〉0. 05）. （3） As for the diseases pattern, there were obvious differences between the two groups. In pregnancy group, the prevalence of hyperthyroidism was lower than that of hypothyroidism （ 1.1% vs 6. 8% , P 〈 0. 01 ） . In control group, the prevalence of hyperthyroidism and hypothyroidism was 4. 7% and 2.2% , respectively （ P 〉 0. 05 ） . Compared with control group, the prevalence of hyperthyroidism in pregnancy group was much lower （ 1.1% vs 4. 7% , P 〈0. 01 ） , mainly due to the decrease of overt hyperthyroidism; whereas, the increment of subclinical hypothyroidism resulted in the higher prevalence of hypothyroidism in pregnancy group （6. 8% vs 2. 2% , P =0. 01）. （4） The median TSH level of the healthy women in pregnancy group was significantly higher than that in control group （2. 50 vs 1.54 mU/L, P 〈 0. 01 ）. The positive rate of TPOAb in pregnancy women was lower than that in nonpregnancy women （3.3% vs 9.4% , P 〈 0. 01 ）. Conclusion At the end of pregnancy, hypothyroidism accounts for most thyroid diseases. Thyroid autoimmunity is suppressed.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2006年第8期529-532,共4页
Chinese Journal of Obstetrics and Gynecology
基金
国家"十五"科技攻关课题资助(2004BA720A30)
