阜阳地区妊娠期亚临床甲减诊断标准和筛查策略的探讨

目的:探讨阜阳地区妊娠期亚临床甲减的诊断标准及筛查策略。方法:选取2015年4月至9月于阜阳市人民医院产科门诊建卡注册的孕妇共2421例。患者完成调查问卷,根据既往疾病史分为高危组及低危组,测定甲状腺功能及TPOAb、TGAb。将受试者按下列诊断标准进行诊断:(1)国外标准组:根据2011年ATA指南建立。(2)我国标准组:根据2012年"中国妊娠和产后甲状腺诊治指南推荐标准"建立。比较上述诊断方法所得亚临床甲减患病率的不同,及高危组及低危组的患病率差异。结果:我国标准诊断亚临床甲减的患病率为3.8%,明显低于国外标准18.7%(P0.001);高危组使用我国标准诊断患病率为5.5%,国外标准为24.1%,均高于低危组,但差异无统计学意义(P0.05)。按我国诊断标准,如仅对高危妊娠妇女进行筛查,妊娠合并亚临床甲减的漏诊率为82.7%。结论:应用国外标准诊断阜阳地区妊娠妇女亚临床甲减的患病率明显高于应用我国标准。如仅对妊娠高危人群进行亚临床甲减的筛查,可能会导致高漏诊率。

Study of two different criteria and screening strategies for subclinical hypothyroidism in ;pregnant women in Fuyang Area

Objective:To investigate two different criteria and screening strategies for subclinical hypothyroidism in pregnant women in Fuyang area. Methods:The study was sur-veyed in population taking their prenatal care from Apr. 2015 to Sep. 2015 at the Fuyang People 's Hospital. There were 2421 pregnant women enrolled in this study. The clinical history of all these women was collected and they were divided into high-risk and low-risk groups. Their ser-um TSH、FT4、FT3、TPOAb、TGAb were recorded and analyzed according to the following two criteria:(1) foreign criterion:according to 2011 ATA guideline;(2) national criterion:accord-ing to 2012 Chinese guidelines for the diagnosis and treatment of thyroid disease during preg-nancy and postpartum. Morbidity rates of subclinical hypothyroidism were compared between different diagnosis and groups. Results:Morbidity rates of subclinical hypothyroidism with na-tional criterion was 3. 8%,lower than 18. 7% with foreign criterion(P<0. 001). In high risk group,morbidity rates of subclinical hypothyroidism with national criterion was 5. 5%,with for-eign criterion was 24. 1%,which was higher than that in low risk group with no statistical sig-nificance(P>0. 05). According to national criterion,if only tested High-risk groups,misdiagno-sis rate of pregnancy with subclinical hypothyroidism would be 82 . 7%. Conclusions:In diagno-sis subclinical hypothyroidism in pregnant women in Fuyang area, morbidity rate with foreign criterion is higher than with national criterion. If only test high-risk groups,misdiagnosis rate of pregnancy with subclinical hypothyroidism may be higher.