摘要
目的探讨妊娠合并甲状腺功能减退症(甲减)患者血清促甲状腺激素(TSH)、同型半胱氨酸(Hcy)、25-羟维生素D3[25(OH)D3]水平变化及临床意义。方法选择2020年3月至2023年3月安徽省皖南康复医院·芜湖市第五人民医院102例妊娠合并甲减患者为研究对象(病例组),另选取同期80名健康产检孕妇为对照组,比较两组血清TSH、游离甲状腺素(FT4)、Hcy及25(OH)D3水平,并分析甲状腺激素与Hcy、25(OH)D3的相关性;根据妊娠合并甲减治疗目标,将患者分为控制组和未控制组,根据妊娠结局将患者分为正常结局组和不良结局组,探究血清甲状腺激素、Hcy、25(OH)D3与患者病情控制效果及妊娠结局的关系。结果病例组血清TSH、Hcy水平均显著高于对照组,25(OH)D3水平显著低于对照组,差异有统计学意义(P<0.05),但两组血清FT4水平比较差异无统计学意义(P>0.05)。Pearson相关分析结果显示,妊娠合并甲减患者血清TSH与Hcy呈正相关、与25(OH)D3呈负相关(P<0.05)。控制组治疗前血清TSH、Hcy水平均显著低于未控制组,而血清25(OH)D3水平显著高于未控制组,差异有统计学意义(P<0.05);病例组不良妊娠结局总发生率显著高于对照组,其中未控制组发生率显著高于控制组,差异均有统计学意义(P<0.05)。正常结局组治疗前血清TSH、Hcy水平均显著低于不良结局组,血清25(OH)D3水平显著高于不良结局组,差异有统计学意义(P<0.05)。结论妊娠合并甲减患者血清TSH、Hcy明显升高,25(OH)D3明显下降,三指标与患者病情控制效果及妊娠结局有关,监测三者变化可为妊娠合并甲减诊疗及预后评估提供参考。
Objective To explore the changes and clinical significance of serum levels of thyroid stimulating hormone(TSH),homocysteine(Hcy)and 25⁃hydroxyvitamin D3[25(OH)D3]in pregnant pa⁃tients with hypothyroidism.Methods 102 pregnant patients with hypothyroidism at Anhui Wannan Rehabilita⁃tion Hospital,the Fifth People's Hospital of Wuhu from March 2020 to March 2023 were selected as the study subjects(case group),and 80 healthy pregnant women during the same period were included in the control group.Serum levels of TSH,free thyroxine(FT4),Hcy and 25(OH)D3 were compared between the two groups.The correlation between thyroid hormones and Hcy and 25(OH)D3 was analyzed.The patients were di⁃vided into the controlled group and the uncontrolled group based on the treatment objectives for pregnancy with hypothyroidism.Additionally,the patients were classified into a normal outcome group and adverse outcome group based on the pregnancy outcomes.The relationship of serum thyroid hormones,Hcy and 25(OH)D3 with disease control effect and pregnancy outcomes was explored.Results The levels of serum TSH and Hcy in the case group were significantly higher than those in the control group while the 25(OH)D3 level was sig⁃nificantly lower than that in the control group(P<0.05).However,there was no statistically significant differ⁃ence in serum FT4 levels between the two groups(P>0.05).Pearson correlation analysis results showed that se⁃rum TSH in pregnant patients with hypothyroidism was positively correlated with Hcy and negatively correlat⁃ed with 25(OH)D3(P<0.05).Before treatment,serum TSH and Hcy levels in the controlled group were sig⁃nificantly lower than those in the uncontrolled group(P<0.05),while serum 25(OH)D3 levels wwere signifi⁃cantly higher than those in the uncontrolled group(P<0.05).The total incidence rate of adverse pregnancy out⁃comes in the case group was significantly higher than that in the control group,and the incidence rate in the un⁃controlled group was significantly higher than that in the controlled group(P<0.05).Before treatment,serum TSH and Hcy levels in the normal outcome group were significantly lower than those in the adverse outcome group(P<0.05),while serum 25(OH)D3 levels were significantly higher than those in the adverse outcome group(P<0.05).Conclusion Serum TSH and Hcy levels are significantly increased,while 25(OH)D3 is significantly decreased in pregnant patients with hypothyroidism.These three indicators are related to the dis⁃ease control effect and pregnancy outcomes.Monitoring changes in the these indicators can provide references for diagnosing,treating,and evaluating the prognosis of pregnancy with hypothyroidism.
作者
闫林林
杨志英
滕艳
汪洪
YAN Linlin;YANG Zhiying;TENG Yan;WANG Hong(Department of Obstetrics and Gynecology,Anhui Wannan Rehabilitation Hospital,the Fifth People's Hos-pital of Wuhu,Wuhu,Anhui,China,241000;Department of Anesthesiology,Anhui Wannan Rehabilita-tion Hospital,the Fifth People's Hospital of Wuhu,Wuhu,Anhui,China,241000)
出处
《分子诊断与治疗杂志》
2024年第5期881-884,889,共5页
Journal of Molecular Diagnostics and Therapy
基金
芜湖市科技计划项目(2021cg50)。
