摘要
目的 获得妊娠早期甲状腺功能异常的患病率,进行妊娠早期甲状腺功能筛查策略的有效性分析.方法调查中国沈阳2 899名妊娠早期妇女（4～12周）.通过问卷调查方法收集所有孕妇的背景资料,将孕妇分为高风险组与非高风险组.应用妊娠早期特异性甲状腺功能正常参考范围,获得妊娠早期甲状腺功能异常患病率.结果高风险组甲状腺功能减退症患病率明显高于非高风险组（16.3%对5.3%,RR=3.1,95%CI 2.4～4.0,P＜0.01）.甲状腺过氧化物酶抗体（TPOAb）阳性（RR=4.7,95%CI3.6～6.0,P＜0.01）,甲状腺疾病个人史（RR=3.2,95%CI 1.9～5.4,P＜0.01）均可显著增加甲状腺疾病患病的风险.高风险组甲状腺功能亢进症的患病率明显高于非高风险组（3.1%对1.4%,RR=2.2,95%CI 1.2～3.9,P=0.006）.TPOAb阳性（RR=2.6,95%CI 1.3～5.0,P=0.007）,甲状腺疾病个人史（RR=4.7,95%CI 1.7～12.5,P=0.006）均可显著增加甲状腺功能亢进发生的风险.高风险组与非高风险组间相比低T4血症患病率差异无统计学意义（0.9%对0.9%,x2=0.008,P=0.928）.仅在高危孕妇中筛查甲状腺功能会漏掉56.7%甲状腺功能减退症（临床和亚临床）患者及64.7%甲状腺功能亢进症（临床和亚临床）患者.结论推荐对妊娠早期所有孕妇进行甲状腺功能的筛查.筛查指标应当包括TSH、FT4和TPOAb.
Objective To use the first trimester-specific reference intervals of thyroid-related hormones to explore the prevalence of thyroid dysfunction during early pregnancy and to analyze effectiveness of different screening strategies. Methods In this study 2 899 pregnant women were enrolled during the first trimester of gestation. TSH, FT4, FT3, and thyroid peroxidase antibody （TPOAb） were measured and thyroid disorders of pregnant women were diagnosed based on the first trimester-specific reference intervals. Results The prevalence of hypothyroidism was significantly higher in the high-risk group than in the non-high risk group （ 16.3% vs 5.3%,RR = 3.1,95% CI 2.4-4.0, P〈0.01 ）. TPOAb （ RR = 4.7, 95 % CI 3.6-6.0, P〈0.01 ）, and personal history of thyroid diseases （ RR=3.2, 95% CI 1.9-5.4, P〈0.01 ） increased the risk of hypothyroidism. The prevalence of hyperthyroidism was higher in the high-risk group （3.1% vs 1.4%, P = 0. 006, RR = 2.2, 95% CI 1.2-3.9, P=0.006）. TPOAb （RR=2.6, 95%CI 1.3-5.0, P=0.007）, and presence of personal history of thyroid diseases（ RR=4.7, 95% CI 1.7-12.5, P=0.006） also increased the risk of hyperthyroidism. 56.7% women with hypothyroidism and 64. 7% women with hyperthyroidism were in the non-high risk group. Conclusion We recommend that screening all pregnant women for thyroid disorders in the first trimester with TSH, FT4, and TPOAb is more effective than the case-finding approach.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2010年第11期926-930,共5页
Chinese Journal of Endocrinology and Metabolism
基金
基金项目：卫生行业科研专项项目（200802008）
辽宁省科学技术计划项目（2007225010）
关键词
妊娠早期
筛查
甲状腺功能异常
风险因素
First trimester pregnancy
Screening
Thyroid dysfunction
Risk factors
