妊娠期亚临床甲状腺功能异常的研究

目的通过检测孕妇妊娠期甲状腺功能,探讨妊娠期亚临床甲状腺功能异常的患病情况及甲状腺过氧化物酶抗体(TPOAb)与甲状腺功能的关系。方法选择2010年10月至2011年7月在北京市海淀妇幼保健院进行常规产前检查的1978例单胎孕妇,并采用系统抽样方法从中抽取TPOAb水平正常(0～9U/ml)的120例妊娠早期(≤12周)和120例妊娠中期(13～24周)孕妇,留取空腹静脉血,检测甲状腺功能及甲状腺自身抗体水平,并对孕妇进行产后随访。结果建立了妊娠早、中期孕妇的促甲状腺激素(TSH)、总甲状腺素(TT4)和游离甲状腺素(FT4)的正常值参考范围。并以此参考值为标准筛出亚临床甲状腺功能减退者82例,单纯低T4血症38例,单纯TPOAb阳性158例,检出率分别为4.15%(82/1978)、1.92%(38/1978)和7.99%(158/1978)。TPOAb阳性组中TSH异常(15.17%)的比例显著高于TPOAb阴性组(6.73%;P<0.001),TPOAb阳性组FT4异常率(7.58%)与TPOAb阴性组(4.98%)比较,差异无统计学意义(P>0.05)。TSH与TPOAb水平呈正相关(r=0.06,P<0.01),但FT4与TPOAb水平无明显相关关系(r=-0.02,P>0.05)。结论 TPOAb阳性与甲状腺功能异常有一定关系,建议妊娠期TPOAb阳性者产后及时复查,监测甲状腺功能的变化。

A study of maternal subclinical thyroid abnormalities during pregnancy

Objective To study the prevalence of maternal subclinical thyroid abnormalities including subclinical hypothyroidism, isolated hypothyroxinemia and positive antithyroid peroxidase antibody （TPOAh） with normal thyroid function and the relationship of TPOAb and thyroid functiorL Methods 1 978 singleton pregnant women who took prena- tal care in Beijing Haidian Maternal and Child Health Hospital were recruited in this study. Serum levels of thyroid stimulating hormone （TSH）, total thyroxine （TT4）, free thyroxine （FT4） and TPOAh were determined at prepartum and postpartum. Results Pregnant specific thyroid funetion reference ranges for the first trimester and second trimester were established by 120 women with 412 gestational weeks （T1 period） and 120 women with 13 to 24 gestational weeks （T2 period）. 82 cases （4. 15%） subclinical hypothyroidism, 38 cases （1.92%） isolated hypothyroxinemia, 158 cases （7.99%） positive TPOAb with normal thyroid function were detected. The proportion of TSH, FT4 abnormalities in positive TPOAb group were higher than that in negative TPOAb group （15.17% vs 6.73%, P〈0. 001; 7.58% vs 4. 98%, P：0. 109）. TPOAb level was positively related to TSH level （r=0.06, P=0. 007） and negatively related to FT4 level （r=-0. 02, P=0. 921）. Conclusion High TPOAh level is related to thyroid dysfunction. It is recommended for pregnant women with abnormal TPOAb to monitor thyroid function after delivery.