摘要
目的探讨产妇不同甲状腺过氧化物酶抗体(TPOAb)水平对新生儿甲状腺功能的影响。方法 2015年1月—2016年6月,选取保定市第一中心医院收治的符合纳入标准的单纯TPOAb阳性产妇33例作为TPOAb阳性组,另选取同期于本院分娩的30例健康产妇作为TPOAb阴性组。所有产妇随访至产后6个月。将新生儿根据其母亲孕晚期TPOAb水平分为N组(母亲为TPOAb阴性组)、A组(母亲为TPOAb阳性组),再将A组新生儿依据其母亲孕晚期TPOAb水平分为A1亚组(母亲孕晚期TPOAb为>30~100 U/ml,n=21)和A2亚组(母亲孕晚期TPOAb>100 U/ml,n=12)。比较N组、A组新生儿出生情况评估资料,N组、A1亚组、A2亚组新生儿出生3~5 d和A1、A2亚组新生儿出生1、3个月甲状腺功能指标[促甲状腺激素(TSH)、游离甲状腺素(FT_4)水平]、甲状腺抗体指标[TPOAb、甲状腺球蛋白抗体(TGAb)、甲状腺球蛋白(TG)水平],并分析TPOAb阳性产妇后代出生3~5 d TSH、FT_4水平与产妇年龄、TPOAb水平的相关性。结果 N组和A组新生儿出生1 min Apgar评分、身长、体质量比较,差异无统计学意义(P>0.05)。A1、A2亚组新生儿出生3~5 d TSH、TPOAb、TGAb、TG水平均高于N组,FT_4水平低于N组(P<0.05);A2亚组新生儿出生3~5 d TSH、TPOAb、TGAb、TG水平均高于A1亚组,FT_4水平低于A1亚组(P<0.05)。A1亚组新生儿出生1个月失访4例。A1、A2亚组新生儿出生1个月FT_4水平比较,差异无统计学意义(P>0.05);A2亚组新生儿出生1个月TSH、TPOAb、TGAb、TG水平高于A1亚组(P<0.05)。A1亚组新生儿出生3个月失访2例。A1、A2亚组新生儿出生3个月FT_4、TPOAb、TG水平比较,差异无统计学意义(P>0.05)。A2亚组新生儿出生1个月TSH、TGAb水平高于A1亚组(P<0.05)。Pearson相关分析结果显示,出生3~5 d时新生儿TSH、FT_4与其母亲TPOAb水平呈正相关(r值分别为0.393、0.423,P值均<0.05)。结论产妇单纯TPOAb阳性对新生儿甲状腺功能有影响,且产妇TPOAb高水平对新生儿甲状腺功能的影响时间更长。
Objective To assess the impact of maternal thyroid peroxidase antibody（ TPOAb） levels on neonatal thyroid function. Methods A total of 33 maternal women,who were positive for TPOAb alone,admitted to the Baoding First Central Hospital between January 2015 and June 2016,and met the inclusion criteria, were enrolled as a TPOAb-positive group. Thirty healthy pregnant women who deliveredat the same hospital during the same period were also recruited as a TPOAb-negative group. All maternal women were followed up until 6 months after delivery. Neonates were assigned into N（ negative maternal TPOAb） or A（ positive maternal TPOAb） groups according to maternal TPOAb levels during late pregnancy. The neonates in group A were further sub-divided into A1（ TPOAb level,30-100 U/ml,n = 21） and A2（ TPOAb level, 100 U/ml,n = 12） subgroups according to maternal TPOAb levels during late pregnancy. Data regarding the assessment of neonatal birth were compared between N and A groups,and thyroid function and thyroid antibodies were tested and compared between neonates in group N and subgroups A1 and A2 3-5 days after birth and between subgroups A1 and A2 1 and 3 months after birth,including thyroid-stimulating hormone（ TSH）,free thyroxine（ FT_4）,TPOAb,thyroglobulin antibody（ TGAb）and thyroglobulin（ TG）. In addition,the association of TSH and FT_4 levels with age and TPOAb level,were also examined in maternal women positive for TPOAb 3-5 days after delivery. Results There were no significant differences in Apgar score 1 min after birth,body length or body weight between groups N and A（ P 〈 0. 05）. Serum TSH,TPOAb,TGAb and TG levels were all significantly greater in subgroups A1 and A2 than in group N 3-5 days after birth（ P 〈 0. 05）. FT_4 levels were significantly lower in subgroups A1 and A2 than in group N（ P 〈 0. 05）,while TSH,TPOAb,TGAb and TG levels were significantly higher in subgroup A2 than in subgroup A1. FT_4 levels were significantly lower in subgroup A2 than in subgroup A1（ P 〈 0. 05）. There were four lost to follow-up in subgroup A1 1 month after birth. There was no significant difference in neonatal FT_4 levels between subgroups A1 and A2 1 month after birth（ P 〈 0. 05）,and significantly higher neonatal TSH,TPOAb,TGAb and TG levels were detected in subgroup A2 than in subgroup A1 1 month after birth（ P 〈 0. 05）. In addition,there were two neonates lost follow-up in subgroup A1 3 months after birth. There was no significant difference in neonatal FT_4,TPOAb or TG levels between subgroups A1 and A2 3 months after birth（ P 〈 0. 05）,and significantly higher neonatal TSH and TGAb levels were detected in subgroup A2 than in subgroup A1 3 months after birth（ P 〈 0. 05）. Pearson correlation analysis revealed that neonatal TSH and FT_4 levels 3-5 days after birth were positively correlated with maternal TPOAb levels（ r = 0. 393 and 0. 423,P 〈 0. 05 in each case）. Conclusion Maternal positive TPOAb influences neonatal thyroid functions and a higher maternal TPOAb level exhibits a longer effect on neonatal thyroid function.
出处
《中国全科医学》
CAS
北大核心
2017年第36期4506-4510,共5页
Chinese General Practice
