妊娠期甲状腺功能及抗体筛查对妊娠结局的影响

目的探讨甲状腺功能及抗体筛查对孕妇妊娠结局的影响。方法 2012-10/2013-10月对750例孕妇行产前甲状腺功能筛查,另选取750名非妊娠妇女为对照组,分别采用免疫吸附法测定两组甲状腺过氧化酶抗体（thyroid peroxidase antibody,TPOAb）、促甲状腺素（thyrotropin,TSH）、总甲状腺素（total thyroxine,TT4）、血清游离甲状腺素（serum free thyroxine,FT4）、游离三碘甲腺原氨酸（free triiodothyronine,FT3）以及总三碘甲腺原氨酸（total triiodothyronine,TT3）水平。结果 750例孕妇中共发现甲状腺功能亢进（甲亢）78例（10.40%）,甲状腺功能减退（甲减）62例（8.27%）,TPOAb阳性25例（3.33%）,而对照组中甲亢12例（1.60%）、甲减8例（1.07%）,TPOAb阳性78例（10.40%）,两组甲亢、甲减及TPOAb阳性率具有统计学差异（P〈0.05）。与正常妊娠组相比,甲减组患者早产、妊娠高血压、孕期贫血、孕期低体重、胎儿窘迫、孕期糖代谢异常发生率显著升高（P〈0.05）,而甲亢组患者子痫前期、孕期心脏病、流产、早产、胎儿窘迫、新生儿生长受限发生率显著升高,差异有统计学意义（P〈0.05）。结论与正常妇女相比,妊娠妇女甲状腺功能异常发生率较高,应引起孕妇及医生的重视。妊娠期甲状腺功能异常患者不良妊娠结局发生率较高,因此临床工作者应重视妊娠期甲状腺功能筛查,做到早筛查,早诊治,以改善患者妊娠结局。

Affect of Thyroid Function and Antibody Screening during Pregnancy on Pregnancy Outcomes

Objective To investigate the effects of thyroid function screening during pregnancy on pregnancy outcome. Methods The levels of thyroid peroxidase antibody（ TPOAb）,thyroid-stimulating hormone（ TSH）,total thyroxine（ TT4）, serum free thyroxine（ FT4）,free triiodothyronine（FT3） and total triiodothyronine（TT3） of 750 cases pregnant women and 750 non-pregnant women were determined. Results In 750 pregnant women,78 cases（10. 40%） had hyperthyroidism,62 cases（ 8. 27%） had hypothyroidism,25 cases（ 3. 33%） had TPOAb positive. In 750 non-pregnant women,12 cases（1. 60%） had hyperthyroidism,8 cases（1. 07%） had hypothyroidism,78 cases（10. 40%） had TPOAb positive. The hyperthyroidism,hypothyroidism,and TPOAb positive rate of two groups were significantly different（ P〈0. 05）. The incidence of premature birth,pregnancy-induced hypertension,anemia during pregnancy,pregnancy low birth weight,fetal distress,abnormal glucose metabolism during pregnancy were significantly higher in hypothyroidism patients than in normal pregnancy（ P〈0. 05）. The rates of pre-eclampsia,heart disease,pregnancy,miscarriage,premature birth,fetal distress,neonatal growth restriction in hypothyroidism patients were significantly increased（ P〈0. 05）. ConclusionThe incidence of thyroid dysfunction of pregnant women were higher than normal women,which should be noticed by pregnant women and doctors. Patients with thyroid dysfunction has higher incidence of adverse pregnancy outcomes. So clinicians should pay attention to the screening of thyroid function during pregnancy and achieve to early screening and early diagnosis and treatment to improve the pregnancy outcome.