摘要
目的 研究妊娠早期甲状腺毒症发病率及妊娠期一过性甲状腺毒症（GTT）与Graves病在甲状腺功能变化情况、妊娠早期临床表现等方面的区别.方法 研究对象来自于2011年至2013年参与《妊娠早期妇女碘铁营养缺乏、亚临床甲状腺激素缺乏：筛查与干预》项目的妊娠12周前妇女（8 105名）,均在妊娠早期（1 ～12周）进行问卷调查、体格检查并检测血清促甲状腺激素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）、尿碘及甲状腺超声,甲状腺毒症患者加测血清游离三碘甲状腺原氨酸（FT3）、促甲状腺激素受体抗体（TRAb）.对71例GTT患者、32例Graves病患者和与之年龄匹配的219名甲状腺功能正常妊娠妇女（对照组）分别在妊娠中期（13 ～27周）、妊娠晚期（≥28周）进行随访.结果 （1）8 105名妊娠妇女中甲状腺毒症患者共109名,甲状腺毒症发病率为1.34％,GTT和Graves病发病率分别为0.90％和0.44％.（2）Graves病患者出现严重甲状腺功能亢进体征的频率显著高于GTT患者（P＜0.05）.GTT和Graves病妊娠早期妇女的甲状腺体积、体重指数与对照组妊娠妇女存在显著差异（P＜0.05）.（3）妊娠各期Graves病患者的TSH、FT4、TRAb、TPOAb与GTT患者存在显著差异（P＜0.05）.妊娠早期Graves病患者FT3显著高于GTT患者（P＜0.05）.Graves病患者在妊娠早、中、晚期TSH、FT4与对照组相比存在显著差异（P＜0.01）.GTT患者妊娠早期、中期TSH、FT4与对照组妇女相比存在显著差异（P＜0.01）,而妊娠晚期FT4与对照组差异无统计学意义.结论 妊娠早期甲状腺毒症以GTT为主,GTT患者甲状腺功能及临床表现与Graves病患者存在显著差异.妊娠中、晚期,GTT患者甲状腺功能均恢复正常,而Graves病患者仍多存在FT4升高,TSH降低.
Objective To study the incidence of maternal thyrotoxicosis in the first trimester and compare thyroid function,clinical manifestations in the first trimester between gestational transient thyrotoxicosis （GTT） and Graves＇ disease.Methods The subjects were selected from 8 105 pregnant women who had participated in the study of ＂Subclinical Hypothyroid during Early Pregnancy＂ from 2011 to 2013.All subjects received questionnaires,physical examination,and thyroid stimulating hormone （TSH）,free T4 （FT4）,thyroid peroxidase antibody （TPOAb）,urinary iodine measurement,and thyroid ultrasonography during the first trimester （1-12 weeks）.Patients with thyrotoxicosis were measured for free T3 （FT3） and thyrotropin receptor antibody （TRAb）.71 patients with GTT,32 patients with Graves＇ disease,and 219 age-matched pregnant women with normal thyroid function in the control group have been followed up during the second trimester（13-27 weeks） and the third trimester（≥28 weeks）.Results （1） The incidences of maternal thyrotoxicosis in the first trimester was 1.34％.GTT 0.90％,and Graves＇ disease 0.44％.（2） The frequency of severe hyperthyroidism signs of patients with Graves＇ disease was significantly higher than that of patients with GTT（P＜0.05）.There were significant difference of body mass index and thyroid volume between GTT or patients with Graves＇ disease and control group.The thyroid volume and body mass index of patients with GTT and patients with Graves＇ disease were significantly different with that of control group （P＜0.01）.（3） TSH of patients with Graves＇ disease was significantly lower than that of patients with GTT during pregnancy,while FT4,TRAb,TPOAb of patients with Graves＇ disease were significantly higher than that of patients with GTT during pregnancy（P＜0.01）.FT3 of patients with Graves＇ disease was significantly higher than that of patients with GTT during the first trimester（P＜0.05）.TSH and FT4 of patients with Graves＇ disease had significantly statistical difference with those of control group during pregnancy （P＜0.01）.TSH and FT4 of patients with GTT had significantly statistical difference with those of control group during the first trimester and the second trimester（P＜0.01）,but TSH of patients with GTT was significantly lower than that of control group （P＜0.05）,and FT4 of patients with GTT had no significantly statistical difference with that of control group during the third trimester.Conclusions GTT is the main causes of thyrotoxicosis in the first trimester.The thyroid function and clinical symptoms of GTT patients and Graves＇ disease were significant different.During the second and third trimesters the thyroid function of GTT patients returned to normal,but still,most of patients with Graves＇ disease had increased FT4 and decreased TSH.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2014年第12期1063-1067,共5页
Chinese Journal of Endocrinology and Metabolism
