摘要
目的动态观察新疆维吾尔自治区孕期妇女甲状腺激素水平及甲状腺自身免疫性抗体随孕期的变化规律,同时探讨不同孕龄甲状腺功能重复筛查意义.方法回顾性收集2015年1月至2017年12月在新疆维吾尔自治区人民医院门诊完善甲状腺功能筛查孕妇的资料,包括促甲状腺素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)等,分析其在孕早、中、晚期的变化规律;同时以30岁为界限分成不同孕龄组,分析甲状腺功能异常率随孕期的变化,探讨在不同孕期重复筛查甲状腺功能的临床意义.结果甲状腺功能指标随孕期的变化:孕早、中、晚期分别为404、725、767例,孕晚期TSH水平(中位数:2.76 mU/L)明显高于孕早、中期(中位数:2.55、2.36 mU/L,P均<0.05),孕早期与孕中期比较差异无统计学意义(P>0.05);FT4、FT3水平随着孕期逐渐下降(P均<0.05);TPOAb阳性率在孕早、中期明显高于孕晚期(P均<0.05),孕早期与孕中期比较差异无统计学意义(P>0.05);TGAb阳性率随着孕期逐渐下降(P均<0.05).TSH异常率比较:孕早、中、晚期分别为352、664、735例,不同孕期总体TSH异常率比较差异有统计学意义(x2=31.627,P<0.05),孕早期明显高于孕中、晚期(P均<0.05);≥30岁年龄组,孕早期TSH异常率明显高于孕中、晚期(P均<0.05);<30岁年龄组,孕早期TSH异常率高于孕晚期(P<0.05);孕早、中、晚期<30、≥30岁年龄组间TSH异常率比较差异无统计学意义(P均>0.05).FT4异常率比较:不同孕期总体,<30、≥30岁年龄组FT4异常率比较差异无统计学意义(P均>0.05);孕早期,≥30岁年龄组FT4异常率高于<30岁年龄组(P<0.05),孕中、晚期两个年龄组比较差异无统计学意义(P均>0.05).结论不同年龄段孕期妇女在孕早期的甲状腺功能筛查均至关重要,除孕早期甲状腺功能异常而未接受治疗的妇女,其余可能不需要重复筛查甲状腺功能.年龄≥30岁孕妇甲状腺功能异常率发生风险可能比年龄<30岁孕妇更高.
Objective To observe the dynamic changes of thyroid hormone levels and thyroid autoimmune antibodies in pregnant women in Xinjiang Uygur Autonomous Region during pregnancy,and to investigate the significance of repeated screening of thyroid function in different gestational ages.Methods A retrospective study was carried out of pregnant women who completed thyroid function screening in Clinic,People's Hospital of Xinjiang Uygur Autonomous Region from January 2015 to December 2017,and the test results of thyroid stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3),thyroid peroxidase antibody(TPOAb),and anti-thyroglobulin antibody(TGAb)were collected and analyzed of their changes during pregnancy.Pregnant women were divided into 2 different gestational age groups by the age limit of 30,the changes of thyroid dysfunction rate with pregnancy were analyzed,and the clinical significance of repeated screening in different pregnancy stages was discussed.Results Changes of thyroid-related indicators with pregnancy:first,second,and third trimesters were 404,725,and 767 cases,respectively;TSH level in the third trimester(2.76 mU/L)was significantly higher than those in the first and second trimesters(2.55,2.36 mU/L,P<0.05),there was no significant difference between the first trimester and the second trimester(P>0.05);the FT4 and FT3 levels decreased gradually with pregnancy(P<0.05);the positive rate of TPOAb was significantly higher in the first and second trimesters than that in the third trimester(P<0.05),there was no significant difference between the first trimester and the second trimester(P>0.05);the positive rate of TGAb decreased gradually with pregnancy(P<0.05).Comparison of abnormal rate of TSH in different gestational ages:the first,second,and third trimesters were 352,664,735 cases,respectively;the abnormal rate of TSH in the overall study was statistically significant at different stages of pregnancy(χ2=31.627,P<0.05),the first trimester was significantly higher those in the second and third trimesters(P<0.05).In pregnant women aged≥30 years old,the abnormal rate of TSH in the first trimester was significantly higher than those in the second and third trimesters(P<0.05);in pregnant women aged<30 years old,the abnormal rate of TSH in the first trimester was significantly higher than that in the third trimester(P<0.05).There were no significant differences in the abnormal rate of TSH in the first,second,and third trimesters between the<30 years old group and≥30 years old group(P>0.05).Comparison of abnormal rate of FT4 in different gestational ages:there were no significant differences in the FT4 abnormal rate among different pregnancy groups in the overall,<30,≥30 years old groups(P>0.05).In early pregnancy,the abnormal rate of FT4 in the≥30 years old group was higher than that in the<30 years old group(P<0.05);in second and third trimesters,there were no significant differences between the two age groups(P>0.05).Conclusions Screening for thyroid function in the first trimester of pregnancy is important for women of different ages.Except for women with abnormal thyroid function who have not been treated during the first trimester,the rest may not need to be screened again.Pregnant women aged≥30 years old may have a higher risk of thyroid dysfunction than those<30 years old.
作者
王新玲
热那姑丽·艾克拜尔
罗蕴之
玛依努·玉素甫
陈园
邢淑清
迪丽达尔·依马木
穆叶沙尔·吾拉木
张玉媛
郭艳英
Wang Xinling;Renaguli Aikebaier;Luo Yunzhi;Mayinu Yusufu;Chen Yuan;Xing Shuqing;Dilidaer Yimamu;Muyeshaer Wulamu;Zhang Yuyuan;Guo Yanying(Endocrinology Department,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2020年第5期367-372,共6页
Chinese Journal of Endemiology
基金
新疆维吾尔自治区人民医院院内项目(20173015)。
