摘要
目的：探讨本市妊娠5-7周妇女甲状腺自身抗体对甲状腺激素（ TH）的影响。方法对700例沈阳市妊娠5-7周妇女进行固相化学发光酶免疫法测定血清促甲状腺激素（ TSH）和游离甲状腺素（ FT4），同时用化学发光法测定甲状腺过氧化物酶抗体（ TPOAb）水平。结果⑴早孕妇女尿碘中位数185.5μg/L（碘充足水平）；⑵甲状腺疾病患病率8.7％，其中甲亢1.0％，亚甲亢1.0％，甲减0.1％，亚甲减6.6％。亚甲亢患病率明显低于亚甲减（ P ＜0.01）；⑶孕妇TPOAb阳性检出率11.0％，其中TSH≥2.5 mU/L组20.3％，两者比较差异有统计学意义（ P ＜0.01）。163例TSH≥2.5 mU/L孕妇中有47例TSH≥4.1 mU/L，与TSH≥2.5 mU/L组比较，TSH≥4.1 mU/L组TPOAb阳性率显著升高（ RR＝2.5，95％CI 1.1-6.0， P ＜0.05）。与TSH 0.13-2.5 mU/L组比较，TSH≥2.5 mU/L组TPOAb 阳性率显著升高（RR＝2.4，95％CI 1.3-4.6， P ＜0.01）。 TSH正常组（0.13-4.1 mU/L）TPOAb阳性率显著高于TSH 0.13-2.5 mU/L组（RR＝2.4，95％CI 1.2-4.6， P ＜0.01）。与TSH＜0.13 mU/L组比较，TSH≥2.5 mU/L组和TSH 0.13-2.5 mU/L组TPOAb阳性率无显著变化（ P ＞0.05）；⑷与TPOAb阴性组比较，TPOAb阳性组TSH中位数显著升高（ P ＜0.01）。 TPOAb阳性可显著增加（RR＝4.9，95％CI 2.4-10.2， P ＜0.01）TSH升高的风险，但不显著增加（RR＝1.1，95％CI 0.1-9.3）TSH降低（＜0.13 mU/L）的风险，即不增加甲亢的患病风险；⑸有自然流产史、甲状腺疾病家族史及无疾病史组孕妇TPOAb阳性率比较，差异均无统计学意义（ P ＞0.05），但有自然流产史组高滴度TPOAb与无疾病史组比较差异有统计学意义（χ2＝6.75， P ＜0.05），而有家族史组与无疾病史组比较差异无统计学意义（ P ＞0.05）；⑹与TPOAb阴性孕妇比较， TPOAb阳性孕妇甲状腺功能紊乱的发生率显著增加（ P ＜0.01）。结论本市早期妊娠甲状腺疾病以亚临床甲减为主。 TPOAb阳性可引起TSH异常及甲状腺功能紊乱，孕妇高滴度TPOAb水平对妊娠有不利影响。监测孕妇血甲状腺自身抗体及甲状腺激素水平，可早期发现甲状腺功能异常或先兆流产，并及时干预可提高优生优育质量。
Objective To explore effects of thyroid autoantibodies on thyroid hormone （ TH） during pregnancy 5-7 weeks in Shenyang City.Methods In this study, 700 pregnant women （pregnant 5-7 weeks） in Shenyang City were enrolled.Serum thyrot-ropin （ TSH ） and free thyroxine （ FT 4） levels were determined with solid-phase chemiluminescent enzyme immunoassay method （CMIA）and thyroid peroxidase antibody （TPOAb） concentration with electro chemiluminescent assay （ECLIA）.Results ⑴ The median urinary iodine （ MUI） of early pregnancy women was 185.5 μg/L.Women were iodine-adequate .⑵The overall prevalence of thyroid diseases in early pregnancy was 8.7%.The prevalence of hyperthyroidism was 1.0%.The prevalence of subclinical hyperthy-roidism was 1.0%.The prevalence of hypothyroidism was 0.1%.The prevalence of Subclinical hypothyroidism was 6.6%.The prev-alence of subclinical hyperthyroidism was lower than that of subclinical hypothyroidism （ P 〈0.01 ） .⑶The positive rate of TPOAb in overall pregnancy women was 11.0%,and was 20.3%in group TSH≥2.5 mU/L （ P 〈0.01 ） .The positive rate of TPOAb in group TSH≥4.1 mU/L was significantly higher than that in group TSH≥2.5 mU/L （34.0%vs 20.3%, RR=2.5, 95%CI 1.1-6.0, P〈0.05 ） .The positive rate of TPOAb in group TSH≥2.5 mU/L was significantly higher than that in group TSH 0.13-2.5 mU/L＆amp;nbsp;group （ RR=2.4 , 95%CI 1.3-4.6 , P 〈0.01 ） .The positive rate of TPOAb in group TSH 0.13-4.1 mU/L was significantly high-er than that in group TSH 0.13-2.5 mU/L group （ RR=2.4 , 95%CI 1.2-4.6 , P 〈0.01 ） .The positive rate of TPOAb in group TSH 0.13-2.5 mU/L and TSH≥2.5 mU/L was no significant change relative to that in group TSH 〈0.13 mU/L （ P 〉0.05 ） .⑷The median TSH was 2.2 mU/L in the TPOAb-positive group , and was 1.2 mU/L in the TPOAb-negative group （ P 〈0.01 ） .The positive TPOAb （ RR=4.9 , 95%CI 2.4-10.2 , P 〈0.01 ） also increased the risk of TSH elevation , but not increased the risk of TSH loss （〈0.13 mU/L）（RR=1.1,95%CI 0.1-9.3）.⑸The positive rate of high titer TPOAb（≥500 U/L）in women with his-tory of spontaneous abortion was statistically significant from that in normal women （χ2 =6.75 , P 〈0.05 ） .The positive rate of high titer TPOAb（≥500 IU/ml） in women with history of family history of thyroid diseases was no statistically significant different from that in normal women （ P 〉0.05）.⑹A percentage （29.0%） of pregnancy women with positive TPOAb had dysthyroid .A percentage （6.3%） of pregnancy women with negative TPOAb had dysthyroid （ P 〈0.01）.Conclusions Subclinical hypothyroidism was capital thyroid diseases pattern during early pregnancy .The positive TPOAb caused abnormal TSH and dysthyroid .The history of spontaneous abortion was a risk factor of high titer TPOAb .Pregnant women with high titer TPOAb levels had an adverse effect on pregnancy .Moni-toring of maternal serum thyroid autoantibodies and thyroid hormone level can detect abnormal thyroid function or threatened abortion . A timely intervention can improve the procreation quality .
出处
《中国医师杂志》
CAS
2014年第6期739-742,746,共5页
Journal of Chinese Physician
基金
卫生行业科研专项项目（200802008）
辽宁省科学技术计划项目（2007225010）
