摘要
目的对1组58例产后甲状腺炎（PPr）患者随访观察24个月，确定其持续性甲状腺功能减退（甲减）的发生率及与持续性甲减发生相关的临床和生化因素。方法本研究是在前期PPT患病率调查基础上进行的前瞻性研究。对58例P胛患者在产后12、18和24个月进行随访，询问临床症状、进行体格检查并留取空腹血清，以测定血清促甲状腺素（TSH）、抗甲状腺过氧化物酶抗体（TPOAb）、抗甲状腺球蛋白抗体（TgAb），TSH异常者加测FT4、FT3，和TSH受体抗体（TRAb）。以50名健康产妇为对照。结果58例PPT患者的随访率为91．4％（n=53），产后24个月时持续性甲减的发生率为20．8％（n=11），对照组无甲减发生。甲状腺功能亢进（甲亢）甲减双相型PPT患者持续性甲减的发生率为26．7％（4／15），甲减单相型PPT患者持续性甲减的发生率为63．6％（7／11），而表现为甲亢单相型的27例PPT患者无I例发生持续性甲减。所有发生持续性甲减的PPT患者，在产后6个月时TSH水平均高于4．8mU／L，并且其分娩时和产后12个月时的TSH均显著高于仅发生一过性甲减的PFr患者（均P〈0．01）。53例PPT患者产后12、18、24个月时TPOAb阳性率分别为56．6％、50．9％和52．8％，TgAb阳性率分别为35．8％、30．2％和30．2％，均显著高于对照组；临床P胛患者各月份TPOAb阳性率和滴度均高于亚临床PPT患者，其中产后18个月和24个月时点的比较差异有统计学意义（均P〈0．05）。结论20．8％的P胛患者在产后24个月时持续甲减，持续性甲减的发生与PPT的病程特点、分娩时及产后的TSH水平有关。
Objective To investigate the cumulative incidence of persistent hypothyroidism in patients who were diagnosed as postpartum thyroiditis （ PPT）, and to determine the factors associated with the development of persistent hypothyroidism in those patients. Methods The present study was performed as the continuous study followed by the former epidemiological survey on PPT, in which 58 patients with PPT （ 35 overt PPT and 23 subclinical PPT） were diagnosed. The 58 patients were followed up at 12th month postpartum, and then for every 6 months until 24 months postpartum. Fasting blood samples were taken for testing serum TSH, thyroid peroxidase antibody （ TPOAb）, and thyroglobulin antibody （TgAb）. Free T3 （ FT3 ）, free T4 （ FT4 ） , and TSH receptor antibody （ TRAb ） were detected ifTSH was abnormal. 50 healthy postpartum women were used as control group. Results Of the total 58 PPT patients, 91.4% （n = 53 ） were successfully followed. Five patients with overt PPT and 6 patients with subclinical PPT developed persistent hypothyroidism, and the cumulative incidence of persistent hypothyroidism in the studied PPT patients was 20.8%. Among 15 PPT patients who had a classical biphasic course （ a thyrotoxic phase followed by a hypothyroid phase）, persistent hypothyroidism was seen in 26. 7% （n = 4 ）. Among 11 PPT patients with hypothyroidism only, persistent hypothyroidism was seen in 63.6% （ n = 7 ）. On the contrary, none of the patients with thyrotoxicosis only had persistent hypothyroidism. All of the patients who developed persistent hypothyrodism had a higher TSH levels than 4.8 mU/L at 6th month postpartum. Before dehvery, TSH levels of the patients developed persistent hypothyroidism were significantly higher than those of the patients with transient hypothyroidism, and this was the case at the 12th month postpartum （ all P〈0.01 ）. PPT patients maintained a relatively higher rate of thyroid autoantibodies. The positive rate of TPOAb at the 12th, 18th, and 24th month postpartum was 56.6%, 50.9%, and 52.8%, respectively; and the positive rate of TgAb being 35.8%, 30.2%, and 30.2%, respectively. Both the positive rate and titer of TPOAb in patients with overt PPT were higher than those in patients with subclinical PPT at the 18th and 24th month postpartum （P 〈 0.05 ）. Conclusions 20.8% patients with PPT developed persistent hypothyroidism at the 24th month postpartum. Whether a patient with PPT would develop persistent hypothyroidismdepends on his clinical feature and TSH level.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2012年第5期372-376,共5页
Chinese Journal of Endocrinology and Metabolism
基金
国家十五科技攻关计划（2004BA720A30）
关键词
产后甲状腺炎
持续性甲减
一过性甲减
甲状腺自身抗体
Postpartum thyroiditis
Persistent hypothyroidism
Transient hypothyroidism
Thyroidautoantibodies
