摘要
目的:探讨不同标准诊断妊娠早期亚临床甲状腺功能减退(SCH)及甲状腺过氧化物酶抗体(TPOAb)阳性对妊娠的影响。方法:收集单胎孕妇740例。分别按照2011年美国甲状腺协会标准(ATA)、2017年ATA、2012年国内制定的《妊娠及产后甲状腺疾病诊治指南》及陕西省人民医院放免中心检测甲功试剂盒的TSH参考范围上限值诊断SCH,比较各SCH诊断标准组之间TPOAb的表达情况及其对妊娠的影响。结果:①2011年ATA标准组、国内标准组、2017年ATA标准组及本院诊断组SCH的发病率分别为30.68%、2.03%、7.84%及7.16%。此外,各标准组内,TPOAb(+)组SCH的发病率均显著升高(P<0.05)。②与对照组相比,各标准诊断的SCH孕妇的流产、早产、胎膜早破、羊水少及胎儿生长受限的发病均显著升高(均P<0.05)。③2011年ATA组、2017年ATA组及本院标准组内,TPOAb(+)者流产、早产、妊娠期高血压、妊娠期糖尿病及胎儿生长受限的发病率均显著升高(均P<0.05);而在国内标准组内,TPOAb(+)者早产及胎儿生长受限的发病率显著升高(P<0.05)。结论:①应采用本地区特异性标准或2017年ATA指南标准推荐的TSH参考值,从而有利于SCH的早期诊断,以保证母婴安全。②亚甲减合并TPOAb阳性与不良妊娠结局密切相关,孕期应常规检查TPOAb表达,以减少不良妊娠结局发生。
Objective:To investigate the influence of different criteria in the diagnosis of subclinical hypothyroidism(SCH)and positive thyroid peroxidase antibody(TPOAb)on pregnancy outcome.Methods:A total of 740 singleton pregnant women were collected.SCH was diagnosed according to the upper limit of TSH reference range recommended by the American Thyroid Association(ATA)criteria in 2011 and 2017,the guideline of the Chinese Medical Asscoaition for the“Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum”in 2012 and the criteria of thyroid function test kit in our hospital.The expression of TPOAb and its influence on pregnancy outcome were compared among different SCH diagnostic criteria groups.Results:The incidence rate of SCH in 2011 ATA criteria group,the national criteria group,2017 ATA criteria group and our hospital criteria group was 30.68%,2.03%,7.84% and 7.16%,respectively.Additionally,the prevelance of SCH in TPOAb(+)in each criteria group was significantly higher in all criteria groups.The incidences of miscarriage,premature delivery,premature rupture membrane,oligohydramnios and fetal growth restriction of SCH pregnant women in each criteria group were significantly higher in comparison with those in control group(all P<0.05).In 2011 ATA criteria group,2017 ATA criteria group and our hospital criteria group,the incidences of miscarriage,premature delivery,gestational hypertension,gestational diabetes mellitus and fetal growth restriction of TPOAb positive cases were significantly higher in comparison with those of TPOAb negative cases(all P<0.05).Moreover,the incidences of premature delivery and fetal growth restriction in TPOAb positive cases in national criteria group were significantly increased in comparison with those in TPOAb negative cases(all P<0.05).Conclusion:The reference value of TSH recommended by local specific criteria or 2017 ATA guidelines should be adopted to facilitate the early diagnosis of SCH and ensure the safety of mother and infant.Hypothyroidism combined with positive TPOAb is closely related to adverse pregnancy outcomes.The expression of TPOAb in pregnant women should be detected routinely during pregnancy to reduce the occurrence of adverse pregnancy outcomes.
作者
韩曦
康佳
何小荣
王亚琴
胡盈
袁峰
HAN Xi;KANG Jia;HE Xiaorong;WANG Yaqin;HU Ying;YUAN Feng(Department of Obstetrics,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)
出处
《陕西医学杂志》
CAS
2022年第7期843-847,共5页
Shaanxi Medical Journal
基金
陕西省创新能力支撑计划项目(2018PT-12)。
