孕妇甲状腺超声测量参数界定及其与甲状腺功能关系的研究

目的探讨孕妇甲状腺超声测量参数与甲状腺功能的关系，寻找最佳评估参数。 方法选取2017年2月至9月在舟山市妇幼保健院体检的120例孕妇，分为妊娠早期组（9~12周）40例，妊娠中期组（16~24周）40例，妊娠晚期组（32~36周）40例，同时选取甲状腺功能正常的非妊娠妇女40名作为对照组，超声测量各组甲状腺各径大小及阻力指数（RI）、舒张末期血流速度（PDV）和收缩期最大血流速度（PSV），全自动生化分析仪检测各组促甲状腺激素（TSH）、游离三碘甲腺原氨酸（FT3）和游离甲状腺素（FT4）水平。 结果4组妇女甲状腺上下径、左右径及前后径以及甲状腺上动脉RI和PDV比较，差异无统计学意义（P>0.05）；妊娠早期组、妊娠中期组和妊娠晚期组PSV均明显高于对照组，差异有统计学意义（F=7.224，P<0.05），其中妊娠晚期组PSV为（28.03±8.10）cm/s，明显低于妊娠早期组的（34.52±8.03）cm/s，差异有统计学意义（t=3.599，P<0.01）；妊娠早期组和妊娠中期组TSH水平明显低于妊娠晚期组和对照组，差异有统计学意义（P均<0.05），其中妊娠早期组最低，为1.09（0.24，3.20）mU/L；妊娠早期组、妊娠中期组和妊娠晚期组FT3和FT4均明显低于对照组，差异有统计学意义（P均<0.05），其中妊娠晚期组FT3和FT4分别为4.10（3.61，4.55）pmol/L和12.20（8.73，15.01）pmol/L，明显低于妊娠早期组和妊娠中期组，差异有统计学意义（P均<0.05）。孕妇PSV与TSH呈负相关（r_s=-0.334，P<0.05），与FT3和FT4呈正相关（r_s=0.364、0.377，P均<0.05）。 结论孕妇甲状腺上动脉血流PSV明显高于非妊娠妇女，其与孕妇甲状腺激素TSH、FT3和FT4有关。动态检测孕妇PSV对于妊娠妇女甲状腺功能评估具有重要意义。

Definition of thyroid ultrasound parameters and its relationship with thyroid function in pregnant women

ObjectiveTo investigate the relationship between thyroid ultrasound parameters and thyroid function in pregnant women, and to find the best parameters. MethodsFrom February 2017 to September 2017, 120 pregnant women were examined in the Maternal and Child Health Care Hospital of Zhoushan, they were divided into early trimester group (9~12 weeks, 40 cases), mid trimester group (16~24 weeks, 40 cases), late trimester group (32~36 week, 40 cases). Forty cases of non-pregnant with normal thyroid function women were selected as control group. The diameters and resistance index (RI), end diastolic blood flow velocity (PDV) and peak systolic velocity (PSV) of each group were measured by ultrasound. The levels of thyroid stimulating hormone (TSH), free tri-iodothyronine (FT3) and free thyroxine (FT4) were detected by automatic biochemical analyzer. ResultsThere were no significant differences in the longitudinal thyroid diameter, transverse diameter, anteroposterior diameter, RI and PDV among the four groups (P>0.05). The PSV in the control group was significantly higher than that of the other three groups (F=7.224, P<0.05). The PSV in late trimester group was (28.03±8.10) cm/s, which was significantly lower than that in early trimester group (34.52±8.03) cm/s (t=3.599, P<0.01). The TSH in the early trimester group and the mid trimester group was significantly lower than that in the late trimester group and the control group (all P<0.05), and the early trimester group was the lowest, 1.09 (0.24, 3.20) mU/L. The FT3 and FT4 levels in the control group were significantly higher than that of the other three groups (all P<0.05). FT3 and FT4 levels in the late trimester group were 4.10 (3.61, 4.55) pmol/L and 12.20 (8.73, 15.01) pmol/L, respectively, which were significantly lower than those in the early trimester group and the mid trimester group (all P<0.05). There was a negative correlation between PSV and TSH in pregnant women (r_s=-0.334, P<0.05), and positively correlated with FT3 and FT4 (r_s=0.364, 0.377, both P<0.05). ConclusionsThe blood flow parameters PSV of superior thyroid artery in pregnant women is significantly higher than those in non-pregnant women, which is related to thyroid hormone (TSH, FT3 and FT4). Dynamic assessment of PSV in pregnant women is of great significance for evaluating thyroid function assessment in pregnant women.