摘要
目的探讨单纯甲状腺过氧化物酶抗体（TPOAb）阳性（指高于正常参考值）与妊娠不良结局的关联以及对其进行临床干预的必要性；探讨孕产妇TPOAb变化特点及临床干预对其走势的影响。方法收集了2012年6月至2015年2月定期随访的TPOAb阳性孕产妇189例，根据甲状腺功能分为：组1（n=122例），单纯TPOAb阳性伴甲状腺功能正常者；组2（n=67例），TPOAb阳性合并TSH升高并接受左旋甲状腺素（L—L）干预者；另设组3（n=120名），TPOAb阴性的健康孕妇。孕期定期随访甲状腺功能至产后6周。结果与组3比较，组1患者的胎膜早破、羊水异常及胎儿窘迫的患病风险升高．相对危险度（RR）分别为3．066、4．782、2．605（均P〈0．01），而妊娠期糖尿病、妊娠期高血压、早产、不良孕产史差异无统计学意义（P〉0．05）。与组3比较，组2患者的胎膜早破、羊水异常与胎儿窘迫风险增加，RR分别为3．830、5．537、3．600（均P〈0．01），而妊娠期糖尿病发生率、妊娠期高血压、早产、不良孕产史差异无统计学意义（P〉0．05）。组1与组2比较，上述各观察指标之间差异无统计学意义（P〉0．05）。TPOAb变化趋势：组1、组2的TPOAb水平从T1期（妊娠早期）到B期（妊娠晚期）均呈下降趋势，产后6周再次升高，两组间同期的中位数值差异未见明显统计学意义（均P〉0．05）。结论单纯TPOAb阳性孕妇的胎膜早破、羊水异常及胎儿窘迫的发生率明显高于健康孕妇；纠正TPOAb阳性孕妇的甲状腺功能仍然不能降低其妊娠不良结局。妊娠期TPOAb从T1期至113期整体呈下降趋势，产后6周再次升高；L—T4干预对TPOAb孕期的走势无明显影响。
Objective To explore the correlation between simple thyroid peroxidase antibody （TPOAb） positive （ higher than the normal reference value ） and the adverse pregnancy outcomes ; and to discuss the necessity of clinical intervention on TPOAb positive and the characteristic of gestational thyroid peroxidase antibody changes. To study wether clinical intervention affects its direction. Methods Subjects were selected from TPOAb positive pregnant women during June 2012 to February 2015. They were registered regularly for thyroid function during pregnancy and 6 weeks postpartum, and timely treated for abnormal thyroid function. They were grouped according to the thyroid function ： Group 1 （ n = 122 ）, simple TPOAb positive group ; Group 2 （ n = 67 ）, patients with elevated TSH and positive TPOAb who accept the levothyroxine （ L-T4 ） intervention ; Group 3 （ n = 120 ） , TPOAb negative healthy pregnant women. They were regularly tested for thyroid function during pregnancy, and with follow-up until 6 weeks postpartum. Results When Group 1 compared with Group 3 ： the risk of premature rupture of membranes, abnormal amniotic fluid, and fetal distress rate increased, the relative risk （RR） were 3. 066,4. 782, 2. 605, all P 〈0.01, while the gestational diabetes, gestational hypertension, preterm birth, abnormal gestation and birth showed no statistical differences （ P〉0.05 ）. When Group 2 compared with Group 3, the risk of premature rupture of membranes, abnormal amniotic fluid, and fetal distress increased （RR were 3. 830, 5. 537, 3. 600 respectively, all P 〈 0.01 ）. While gestational diabetes, gestational hypertension, preterm birth, abnormal gestation and birth did not show any statistical difference （ P〉0.05 ）. Compared with Group 2, Group 1 had no statistical difference between the above observational parameters. The levels of TPOAb from stage T1 （ the first trimester） to T3 （ the third trimester） showed a overall downward trend in Group 1 and Group 2, rise again six weeks after child birth. Comparison of the two groups （ Group 1 and Group 2）, the median value during this period did not reveal any significantly statistical differences （ P〉0.05 ）. Conclusion In simple TPOAb positive pregnant women, premature rupture of membranes, abnolxaality in amniotic fluid, and fetal distress were significantly higher than those in healthy pregnant women; even with thyroid function correction the TPOAb positive pregnant women still cannot reduce the adverse pregnancy outcomes. Levels of TPOAb from T1 to T3 presented the overall downward trend and to rise again six weeks after pregnancy. L-T4 intervention for TPOAb positive pregnancy did not show any significant effect.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2015年第12期1041-1045,共5页
Chinese Journal of Endocrinology and Metabolism
