548例妊娠期甲状腺功能筛查指征及亚临床甲减对妊娠结局影响的分析

目的回顾性分析妊娠期甲状腺功能的筛查指征及阳性率;阐明妊娠合并亚临床甲减对妊娠结局的影响。方法 2008年1月至2010年12月在北京大学第一医院产科分娩的孕妇行甲状腺功能检测者548例,对其筛查指征进行比较;对TSH水平正常孕妇的FT4水平按妊娠时期分类,取妊娠特异性FT4水平的95%可信区间作为本研究FT4的正常参考值,分组比较亚临床甲减组和对照组孕妇不良妊娠结局的差异。结果 548例孕妇中发现高TSH血症111例,应用高危因素筛查策略仅能检出49例（44.1%）;TSH正常组FT4水平行妊娠周期特异性分组,妊娠早、中、晚期FT4的水平呈下降趋势,组间P值均〈0.001;得出的FT4的频率分布95%可信区间作为参考值,对两组（亚临床甲减组和对照组）孕妇不良妊娠结局进行比较,两组间差异无统计学意义（P〉0.05）。结论实施高危因素的甲状腺功能筛查策略甲状腺功能异常漏诊率较高;尚未发现亚临床甲减与孕妇不良妊娠结局之间的相关性。

The screening indication of thyroid function of 548 cases and the effects of subclinical hypothyroidism on pregnancy outcomes

Objective To study the screening indications of thyroid function of pregnancy and the effects of subclinical hypothyroidsm on pregnancy outcomes.Methods 548 pregnant women who delivered in Peking University First Hospital between 2008 and 2011 were recruited in this study,thyroid function were measured during different trimester and 111 women were identified with abnormal TSH level.For those with normal TSH level,we regrouped them according FT4 95% CI,90 cases were in hypothyroidsm group and the other 368 cases were in normal group（control）,the pregnancy outcomes were compared betweent the two groups.Results Using high-risk strategy,there were only 49 cases（44.1%）could be detected with hypothyriodsm among the 111 cases with high TSH level;With the gestation weeks increased,the level of FT4 declined（P＆lt;0.001）.The distribution frequency of FT4 95% CI was 11.24~18.05pmol/L in the first trimester,9.82~14.70pmol/L in the second trimester and 9.22~13.80pmol/L in the third trimester.There was no significant difference of the pregnancy outcomes between the two groups（according the FT4 95% CI）（P＆gt;0.05）。Conclusion The misdiagnosis rate of high-risk screening strategy of thyroid function for the pregnant women is high,there was no correlation between subclinical hypothyroidsm and adverse pregnancy outcomes.