TPOAb对妊娠期亚临床甲状腺功能减退女性妊娠结局的影响

目的 研究甲状腺过氧化物酶抗体不同情况下妊娠期亚临床甲状腺功能减退女性妊娠结局的影响.方法 将2013年3月至2014年12月在南通市妇幼保健院早孕门诊检测发现的围产档案完整且在南通市妇幼保健院分娩的符合要求的妊娠期亚临床甲状腺功能减退女性73人作为研究对象,将其中甲状腺过氧化物酶抗体阳性入观察A组(n=25),阴性入观察B组(n=48),同期用南通市妇幼保健院妇女营养科营养软件(雅培围产营养规划V2.0)中记录的同期正常早孕妇女,随机抽取60人作为对照组.观察比较三组女性妊娠期糖尿病、妊娠期高血压、前置胎盘、胎盘早剥和产后出血发生率,同时观察三组新生儿低体重、巨大儿、早产、新生儿低血糖和胎儿窘迫的发生率.结果 三组女性妊娠期糖尿病、妊娠期高血压、前置胎盘、胎盘早剥和产后出血发生率比较,差异有统计学意义(妊娠期糖尿病x2=9.82、P=0.03;妊娠期高血压x2=15.75、P=0.01;前置胎盘x2=4.16、P =0.04;胎盘早剥x2=6.37、P=0.04;产后出血发生率x2=7.54、P=0.04),观察A组较观察B组发生率更高(妊娠期糖尿病x2 =6.75、P=0.04;妊娠期高血压x2=6.75、P=0.04;前置胎盘x2=7.33、P=0.04;胎盘早剥x2 =6.92、P=0.04;产后出血发生率x2=8.54、P=0.04),差异有统计学意义.三组新生儿低体重、巨大儿、早产、低血糖和胎儿窘迫的发生率比较,差异有统计学意义(新生儿低体重发生率x2=11.27、P=0.02;巨大儿发生率x2=9.75、P=0.03;早产发生率x2=13.16、P=0.02;低血糖发生率x2=8.02、P=0.04;胎儿窘迫发生率x2=12.54、P=0.02),观察A组更高(新生儿低体重发生率x2=8.54、P=0.04;巨大儿发生率x2=5.69、P=0.04;早产发生率x2 =9.25、P=0.03;低血糖发生率x2 =5.36、P=0.04;胎儿窘迫发生率x2=6.23、P=0.04),差异有统计学意义.结论 妊娠期亚临床甲状腺功能减退会引起母婴不良妊娠结局,而甲状腺过氧化物酶抗体阳性会加重不良妊娠结局.

Effect of thyroid peroxidase antibody on pregnancy outcomes of women with subclinical hypothyroidism

Objective To study the effect of thyroid peroxidase antibody on pregnancy outcomes of women with subclinical hypothyroidism during pregnancy.Methods From March 2013 to December 2014 73 cases of subclinical hypothyroidism with complete perinatal documents and delivering in the hospital were selected as subjects.According to the index of thyroid peroxidase antibody positive or negative,the cases were divided into group A (n =25,positive) and group B (n =48,negative).Meanwhile,60 healthy pregnant women were selected from the record of nutrition software as control group.The incidence of gestational diabetes,pregnancy hypertension,placenta previa,placental abruption and postpartum hemorrhage was compared among three groups,and the incidence of low birth weight,fetal macrosomia,premature delivery,neonatal hypoglucemia and fetal distress of newborns was observed in three groups.Results There were significant differences in the incidence of gestational diabetes,gestational hypertension,placenta previa,placental abruption and postpartum hemorrhage among three groups (x2 value was 9.82,15.75,4.16,6.37 and 7.54,respectively,P value was 0.03,0.01,0.04,0.04 and 0.04,respectively),and the incidence in group A was higher than in group B (x2 value was 6.75,6.75,7.33,6.92 and 8.54,respectively,all P =0.04).The differences were statistically significant.Three groups were significantly different in the incidence of low birth weight,fetal macrosomia,premature delivery,neonatal hypoglucemia and fetal distress (x2 value was 1 1.27,9.75,13.16,8.02 and 12.54,respectively,P value was 0.02,0.03,0.02,0.04 and 0.02,respectively).The incidence of them was higher in group A (x2 value was 8.54,5.69,9.25,5.36 and 6.23,respectively,P value was 0.04,0.04,0.03,0.04 and 0.04,respectively) with statistical significance.Conclusion Subclinical hypothyroidism in pregnant women can cause maternal and neonatal adverse outcomes,and thyroid peroxidase antibody positive will aggravate adverse outcomes.