妊娠一过性甲状腺毒症的临床研究

目的 调查沈阳地区既往健康的妇女妊娠早期妊娠一过性甲状腺毒症(GTT)的患病率及其病因.方法 对来自沈阳地区10家医院的534例妊娠早期妇女进行问卷调查、体格检查、血清促甲状腺素(TSH)、游离T4(FT4)、游离T3(FT3)、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺素受体抗体(TRAb)和人绒毛膜促性腺激素(hCG)水平的检测.结果 (1)妊娠早期甲状腺毒症总患病率为9.75%,GTT的患病率为7.86%,占甲状腺毒症的80.77%;88.89%临床GTT表现为单纯FT3升高.(2)妊娠6、8～10和12周孕妇血清hCG水平逐渐升高,中位数分别为25300、85220和81780IU/L(P=0.000).血清TSH中位数依次降低(P＜0.01),分别为1.45、1.10和0.84mIU/L.(3)当妊娠妇女血清hCG水平＞50 000 IU/L时,GTT的比例明显升高;当血清hCG水平在80 000～110000IU/L时发生亚临床GTT的比例明显升高;当血清hCG水平＞110 000IU/L时发生临床CTT的比例明显升高.相关分析结果 显示,妊娠早期血清hCG与TSH显著负相关(r=-0.402,P=0.000),与FT3正相关(r=0.165,P=0.000),而与FT4无相关.结论 GTT是妊娠早期甲状腺功能亢进症的首要病因,占妊娠早期甲状腺毒症的80.77%,其血清学特点主要表现为血清FTT升高.妊娠早期血清hCG水平与GTT严重程度相关.

A clinical study on gestational transient thyrotoxicosis

Objective To investigate the prevalence of gestational transient thyrotoxicosis(GTT) and analyze the cause of thyrotoxicosis encountered in this period MethodsAn epidemiologic survey in ten hospitals in Shenyang was performed and 534 pregnant women during the first trimester of pregnancy filled questionaire,received physical examination and had serum thyroid-stimulating hormone(TSH),free T4 (FT4),free T3(FT3),thyroid peroxjdase antibody(TPOAb),thyrotrophin receptor antibody(TRAb),and human chorionic gonadotrophin(hCG)tests.Results(1)The total prevalence of thyrotoxicosis was 9.75%(52/534)in the first trimester and the prevalence of Grrr was 7.86%.which accounted for 80.77%of the thyroxicosis encountered in this period.A total of 88.89%of the overt GTT showed only elevated FT3 level.(2)The level of serum hCG increased gradually in the first trimester.The medians of hCG were 25 300,85 220 and 81 780 IU/L 6,8-10 and 12 weeks after gestation.respectively(P=0.000).The medians of serum TSH were 1.45.1.10 and 0.84 mlU/I,6.8-10 and 12 weeks after gestation,respectively(P＜0.01).(3)When segum hCG was more than 50 000 IU/L,the prevalece of GTT increased obviously.When serum hCG was between 80000 IU/L and 110000 IU/L,subclinical GTT increased significantly.When serum hCG was more than 110000 IU/L,overt GTT increased significantly.Correlation analysis showed that serum hCG was related negatively with TSH(r=-0.402,P=0.000)and positively with FT3(r=0.165,P=0.000),but not related with FT4.Conclusions The prevalence of GTT is 7.86%in the first trimester and it is the main cause of thyrotoxicosis found in the first trimester,accounting for 80.77%of all the causes.The serological characteristic of overt GTT is mainly the elevation of serum FT3 leveL Serum hCG level is related with the severity of GTT.