摘要
目的探讨妊娠20周前甲状腺功能异常对妊娠的影响。方法收集陕西省妇幼保健院2011年8月至2012年8月在产科正常产检并分娩的孕妇2 582例的临床资料,采用化学发光法检测血清中促甲状腺激素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb),对妊娠的影响进行前瞻性研究。结果①患病率:妊娠20周前甲状腺功能异常的总患病率为16.08%(415/2 582),其中TSH、FT4异常及TPOAb(+)的发生率分别为2.37%(61/2 582)、2.01%(52/2 582)及10.68%(276/2 582),甲状腺功能减退症、亚临床甲减、低甲状腺素血症、单纯甲状腺自身抗体阳性及甲状腺功能亢进症的患病率分别为0.12%(3/2 582)、2.06%(53/2 582)、4.52%(117/2 582)、8.52%(220/2 582)和0.08%(2/2 582),与TPOAb(-)组比较,TPOAb(+)组中甲状腺功能减退症和亚临床甲减的发病率较高,分别为1.09%(3/276)和11.96%(33/276),差异有统计学意义(P<0.01);②对妊娠影响:甲状腺功能异常组中妊娠并发症或合并症的发生率较正常组高,依次为妊娠期糖尿病(x^2=60.66,P<0.01)、妊娠期高血压疾病(x^2=6.26,P<0.05)、贫血(x^2=6.03,P<0.05),而胎盘早剥(x^2=0.01,P>0.05)的发病率在两组间比较无统计学差异。③妊娠结局:甲状腺功能异常组中不良妊娠结局的发生率较正常组升高,主要表现为低体重儿(x^2=23.26,P<0.01)、早产(x^2=7.65,P<0.01)及流产(x^2=10.67,P<0.01),而胎儿窘迫(x^2=0.62,P>0.05)的发病率在两组间比较无显著差异。结论妊娠20周前甲状腺功能异常对妊娠过程及结局可产生不良影响。
Objective To investigate the influence of abnormal thyroid function on pregnancy prior to the 20th week of gestation.Methods A prospective analysis was conducted on the clinical data of 2 582 pregnant women with normal prenatal care from August 2011 to August 2012 and delivery in Child and Maternity Health Hospital of Shaanxi Province .Serum thyroid stimulating hormone （ TSH） , free thyroxine （FT4） and thyroid peroxidase antibodies （TPOAb） of all patients were detected by using chemiluminescence methods .The influence on pregnancy was prospectively analyzed .Results The total prevalence rate of the abnormal thyroid function was 16.08%（415/2 582） during the first half of pregnancy , and the incidence rate of abnormal TSH , FT4 and TPOAb（＋） was 2.37%（61/2582）, 2.01%（52/2 582） and 10.68%（276/2 582）, respectively.The prevalence rates of hypothyroidism , subclinical hypothyroidism , hypothyroxinemia and pure thyroid peroxidase antibody positive were 0.12% （3/2 582）, 2.06% （53/2 582）, 4.52% （117/2 582）, 8.52% （220/2 582） and 0.08%（2/2 582）, respectively.Compared with TPOAb negative women, the incidence rate of hypothyroidism and subclinical hypothyroidism in TPOAb positive women increased significantly , which was 1.09%（3/276） and 11.96%（33/276）, respectively, and there was statistical difference （P 〈0.01）.Compared with the normal group, the incidence of pregnancy complications in thyroid dysfunction group was significantly higher , which were gestational diabetes （χ2 =60.66,P〈0.01）, gestational hypertension disease （χ^2 =6.26, P〈0.05）, anemia （χ^2 =6.03,P〈0.05）, while the incidence of placental abruption （χ^2 =0.01,P〉0.05） was not significantly different （χ^2 =0.01,P〉0.05）.Compared with the normal group , the incidence of adverse pregnancy outcomes was significantly higher , which were low birth weight （χ^2 =23.26,P〈0.01）, premature delivery （χ^2 =7.65, P〈0.01） and abortion （χ^2 =10.67, P〈0.01）, while the incidence of fetal distress （χ^2 =0.62,P〉0.05） was not significantly different between two groups （χ^2 =0.62,P〉0.05）. Conclusion The abnormal thyroid function during the first half of pregnancy can lead to adverse pregnancy outcomes .
出处
《中国妇幼健康研究》
2013年第5期695-697,700,共4页
Chinese Journal of Woman and Child Health Research
基金
陕西省科技厅社发攻关资助项目(2012K18-03-05):西安地区妊娠期甲状腺功能筛查前瞻性研究
