摘要
目的:观察妊娠早期合并亚临床甲状腺功能减退(SCH)孕妇甲状腺过氧化物酶抗体(TPOAb)阳性对不良妊娠结局的影响。方法:回顾性分析2011年6月至2013年1月在广东省妇幼保健院行妊娠早期促甲状腺激素(TSH)、血清游离甲状腺素(FT_4)、总甲状腺素(TT_4)、TPOAb筛查,并且有妊娠结局的孕妇共13973例。根据检查结果把孕妇分为甲状腺功能正常(N)+TPOAb(-)组、N+TPOAb(+)组、SCH+TPOAb(-)组和SCH+TPOAb(+)组。比较4组孕妇妊娠结局及产科并发症发生情况并进行统计学分析。结果:在13973例孕妇中,N+TPOAb(-)组10179例(72.85%),N+TPOAb(+)组628例(4.49%),SCH+TPOAb(-)组347例(2.48%),SCH+TPOAb(+)组574例(4.11%)。SCH+TPOAb(+)组孕妇流产93例(16.3%)、妊娠期糖尿病133例(23.2%)、早产99例(17.2%),其发生率均高于SCH+TPOAb(-)组,分别为42例(12.1%)、59例(17.0%)、39例(11.2%);高于N+TPOAb(+)组,分别为70例(11.1%)、98例(15.6%)、51例(8.1%)和N+TPOAb(-)组,分别为835例(8.2%)、1033例(10.1%)、794例(7.8%),差异均有统计学意义(P<0.05)。SCH+TPOAb(+)组孕妇胎儿生长受限、胎盘早剥、前置胎盘、足月胎膜早破、出生低体质量儿、巨大儿、新生儿窒息、羊水过多、羊水过少发生率与SCH+TPOAb(-)组、N+TPOAb(+)组和N+TPOAb(-)组比较,差异无统计学意义(P>0.05)。结论:妊娠早期合并SCH且TPOAb(+)可增加流产、早产、妊娠期糖尿病的发生率,建议广泛开展妊娠早期甲状腺功能和TPOAb筛查,早期诊断、早期干预,减低不良妊娠结局风险。
Objective：To investigate the impact of subclinical hypothyroidism（SCH）combined with thyroid per- oxidase antibody （TPOAb） positive in first trimester of pregnancy on adverse pregnancy outcomes. Methods： 13973 first trimester pregnant women were retrospectively collected from June 2011 to January 2013 in Guang- dong Women and Children Hospital, and their thyroid （ TSH, FT4, TT4, TPOAb） screening and pregnancy out- comes were enrolled. Those women were assigned into four groups： thyroid function normal （N） ＋ TPOAb （ - ） group, N ＋ TPOAb （ ＋ ）group, SCH ＋ TPOAb（ - ）group, SCH ＋ TPOAb （ ＋ ）group. The pregnancy outcomes and the incidence of obstetric complications among the four groups were compared. Results：Among the 13973 preg- nant women, N ＋ TPOAb（ - ） accounted for 72.85%, N ＋ TPOAb （ ＋ ） 4.49%, SCH ＋ TPOAb （ - ） 2.48% and SCH ＋ TPOAb （ ＋ ） 4. 11%. In SCH ＋ TPOAb （ ＋ ） group, the incidence of abortion, gestational diabetes mellitus and preterm labor（16. 3% ,23.2% and 17.2%, respectively）was higher than that of SCH ＋ TPOAb（ - ）group （12. 1%,17. 1% and 11.2%）,N ＋TPOAb（ ＋）group（11.1%,15.6% and 8. 1% ,respectively）and N ＋ TPOAb （ - ）group（8.2%, 10.1% ,7.8%, respectively）, and the difference was statistically significant（ P 〈 0.05）. But the incidence of fetal growth restriction, placental abruption, placenta previa,term premature rupture of membranes, low birth weight, giant, neonatal asphyxia, amniotic fluid and amniotic fluid in SCH ＋ TPOAb（ ＋ ） group showed no significant difference when compared to SCH ＋ TPOAb（ - ） group,N ＋ TPOAb（ ＋ ） group and N ＋ TPOAb （ - ） （ P 〉 0.05）. Conclusions： Subclinical hypothyroidism combined with TPOAb （ ＋ ） during early pregnancy could increase the incidence of abortion, preterm laborand gestational diabetes mellitus. Therefor thyroid function and TPOAb screening are recommended to carry out during early pregnancy. Early diagnosis and intervention could reduce the risks of adverse pregnancy outcomes.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2018年第1期34-37,共4页
Journal of Practical Obstetrics and Gynecology
