关注甲状腺疾病与围产期健康

<正>20世纪30年代有学者关注妊娠与甲状腺功能亢进症(甲亢)之间的关系,传统观念认为:母体的甲状腺激素不会通过胎盘影响胎儿。所以此问题一直未引起围产医学界的重视。直至80年代发现:甲状腺激素合成障碍和无甲状腺新生儿的脐带血中存在甲状腺激素,并发现母体甲状腺激素在胎儿脑发育的第1期(妊娠的前20周)的重要地位,于是推翻了这一传统观念。甲状腺功能(甲功)异常包括甲状腺功能减退症(甲减)、亚临床甲减、临床甲亢、亚临     

甲状腺自身抗体对妊娠结局的影响

目的：观察妊娠早期单纯甲状腺过氧化物酶抗体（thyroid peroxidase antibody,TPO-Ab）阳性,是否会增加孕产妇妊娠并发症的发生和影响妊娠结局。方法：收集孕周≤13周且甲状腺功能正常孕妇的临床资料,根据TPO-Ab检测结果将患者分为TPO-Ab（－）组（＜60 kU/L,793例）和TPO-Ab（＋）组（≥60 kU/L,88例）。随访患者甲状腺功能的变化,比较2组患者妊娠结局的差异。结果：TPO-Ab（+）组患者促甲状腺激素（TSH）高于TPO-Ab（－）组（t=2.079,P=0.038）;TPO-Ab（+）组患者胎膜早破、胎儿生长受限（FGR）和低出生体质量儿的发生率高于TPO-Ab（－）组（7.95% vs. 1.89%,χ2=9.598,P=0.002;2.27% vs. 0.37%,χ2=5.126,P=0.024;5.68% vs. 2.12%,χ2=4.180,P=0.041）。结论：TPO-Ab阳性对妊娠期间并发症和妊娠结局存在不良影响。     

妊娠期亚临床甲状腺功能减退的相关指南对比分析

亚临床甲状腺功能减退是一种常见的甲状腺内分泌疾病。很多研究显示妊娠期亚临床甲状腺功能减退可能对妊娠造成不良影响,甚至可能影响胎儿脑发育,但是对其危害以及诊断、如何进行筛查和治疗等多方面,国内外至今仍未达成一致意见。因此,本文拟通过对比分析近十年国内外公开发表的妊娠期亚临床甲状腺功能减退相关指南,为该领域的科研和临床工作者提供参考。     

关于“妊娠期甲状腺功能亢进症诊治指南”的解读

2011年10月发表的《妊娠期及产后甲状腺疾病诊断及治疗指南》是由美国甲状腺协会(The American Thyroid Association,ATA)、亚洲及大洋洲甲状腺协会、拉丁美洲甲状腺学会、美国妇产科医师学会、北美助产士联盟等甲状腺疾病和妊娠方面的国际专家共同制定的。该指南由多个国际专家小组共同制定,所以具有更广泛的代表性和认同性,是妊娠期甲状腺疾病诊治的重要指导方针。由于甲状腺功能亢进症(甲亢)好发于育龄期女性,妊娠期甲亢是产科经常面临的问题,故本文单就有关"妊娠期甲亢的诊治指南"     

双胎妊娠与母体甲状腺功能的研究进展

妊娠期母体甲状腺功能异常是较为常见的妊娠合并症,可致孕妇不良妊娠结局风险增高。目前研究对象多为单胎妊娠,针对双胎孕妇甲状腺功能的研究较少。随着辅助生殖技术的发展,世界范围内双胎妊娠发生率逐年升高。已有研究发现,双胎妊娠合并甲状腺功能异常孕妇较单胎妊娠更易出现流产、子痫前期、胎儿生长受限等。因此妊娠期双胎孕妇甲状腺功能的监测意义重大。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

目的 探讨甲状腺功能减退症(简称甲减)及亚临床甲减对孕产妇妊娠结局及围产儿的影响.方法 回顾性分析2005年1月至2008年3月在北京协和医院妊娠合并甲减(57例)或亚临床甲减(20例)分娩孕妇77例,随机选取同期分娩的正常孕妇79例作为对照,分析三组孕妇的一般临床资料、产时产后并发症及嗣产儿结局.结果 3年间我院妊娠合并甲减的患病率为0.74%,合并亚临床甲减的患病率为0.26%,凡呈逐年升高趋势.妊娠合并甲减组新生儿平均出生体重低于对照组[(3191.8±659.4)g和(3301.9±423.1)g,P<0.05],妊娠期糖代谢异常发生率(24.6%)及小于胎龄儿的发生率(12.3%)均高于对照组(分别为11.4 %和2.5%)(P<0.05).妊娠合并亚临床甲减组各项妊娠期并发症的发生率与对照组比较,均无统计学意义.结论 妊娠合并甲减及亚临床甲减的患病率逐年上升,即使经过治疗,甲减或亚临床甲减孕妇小于胎龄儿等并发症的发生几率仍增加.对高危人群早期筛查、充分治疗是改善妊娠结局的最好方法.     

妊娠合并甲状腺功能低减患者的临床分析

目的 探讨妊娠合并甲状腺功能低减(甲减)患者的围产期发病率、药物治疗剂量及母婴结局.方法 收集我院1995年1月-2006年5月收治的31例妊娠合并甲减患者的临床资料,31例患者均在产科高危门诊定期保健,每1.0～1.5个月监测1次甲状腺功能,并与内分泌科合作调整患者的左旋甲状腺素剂量.对患者的围产期保健、药物治疗量及母婴结局进行回顾性分析.结果 (1)发病率:我院近11年来妊娠合并甲减的发病率为1.27‰(31/24 327)[0.19‰(1/5251)～2.32‰(15/6456)].(2)左旋甲状腺素用量:左旋甲状腺素的平均剂量孕前、孕早期、孕中期、孕晚期、产后分别为(33±35)、(51±36)、(68±42)、(76±42)、(38±34)μg/d,孕早期及产后与孕前比较,差异无统计学意义(P＞0.05);孕中期及孕晚期与孕前比较,左旋甲状腺素应用量明显增加,差异有统计学意义(P＜0.05),整个孕期的左旋甲状腺素平均用量比孕前增加约35%.(3)妊娠结局:31例患者中有5例妊娠期糖代谢异常,发生率为16%(5/31);1例胎儿六指畸形,1例新生儿窒息(Apgar评分1分钟7分,5分钟10分);31例患者中无一例围产儿死亡,无新生儿先天性甲减.结论 妊娠合并甲减发病率逐年升高.孕期需及时增加左旋甲状腺素用量,对改善妊娠合并甲减患者的妊娠结局具有良好的治疗作用.     

妊娠合并甲状腺功能减退26例临床分析

目的探讨妊娠合并甲状腺功能减退（甲减）患者的围生期特征及母婴结局。方法对26例妊娠合并甲减患者的临床资料进行回顾性分析,并选择正常孕妇30例作为对照组,比较两组患者的妊娠结局。结果妊娠合并甲减的发病率为1.21‰（26/21 527）。26例患者中,妊娠前诊断22例,妊娠中诊断4例;并发子痫前期3例,其中轻度子痫前期2例,重度子痫前期1例;贫血5例,其中轻度贫血3例,中度贫血2例;流产1例,妊娠32周胎盘早剥致死胎1例,早产3例;新生儿阴茎缺如1例。无新生儿先天性甲减。26例患者中,21例规范治疗,5例未规范治疗;妊娠期平均左旋甲状腺素用量（43.1±40.6）ug/d;规范治疗组并发症发生率（52.3%,11/21）与未规范治疗组（4/5）比较,差异有统计学意义（P〈0.05）;甲减组总并发症发生率（57.6%,15/26）与对照组（13.3%,4/30）比较,差异有统计学意义（P〈0.05）。结论妊娠合并甲减发病率低,妊娠期动态监测甲状腺功能并规范治疗可改善母婴结局。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠期孕妇甲状腺功能检测的价值与意义

目的 探讨妊娠期孕妇甲状腺功能检测的价值与意义。方法 选取本院50例妊娠期孕妇为试验组,50例同期体检的非妊娠女性为对照组,均行甲状腺功能检测,比较两组的检测结果和甲状腺功能异常情况。结果 试验组甲状腺素、游离甲状腺素水平高于对照组,差异有统计学意义（P<0.05）;随着孕周增加,促甲状腺激素水平渐渐升高,而甲状腺素、游离甲状腺素、游离三碘甲腺原氨酸水平逐渐降低,差异有统计学意义（P<0.05）;试验组甲状腺功能异常发生率为18.00%,高于对照组的4.00%,差异有统计学意义（P<0.05）。结论 妊娠期孕妇甲状腺功能指标同非妊娠女性存在差异,且相关指标会随着孕周增加而变化,孕期加强甲状腺功能检测有利于尽早检出甲状腺疾病,确保母婴健康。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺病的诊断与治疗

妊娠合并甲状腺病,最常见的是甲状腺功能亢进、功能低下、桥本氏病、单纯性甲状腺肿和结节性甲状腺肿等。一般轻症或经过系统治疗的甲状腺病不影响妊娠,临床表现也不明显,故一般孕期检查时产科医师多不注意检查甲状腺及其功能。但是,由于重症和不易控制的甲状腺功能亢进或低下,容易引起流产、早产、死胎、死产及胎儿宫内生长迟缓(IUGR)、畸形,也容易引起妊娠高血压综合征、产时宫缩乏力出血、产后感染,甚至发生甲状腺危象。所以,近些年来随着围产医     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.