妊娠早期甲状腺功能及其抗体对自然流产的影响和预测价值

目的探讨妊娠早期甲状腺功能及抗体对自然流产的影响及预测价值。方法选择2014年1~6月因早孕于四川省妇幼保健院检查并同意参加调查的621名育龄妇女的临床资料,常规筛查甲状腺功能,包含血清促甲状腺素(thyroid stimulating hormone,TSH)、血清游离甲状腺素(free thyroxine,FT4)、血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及甲功抗体(thyroid auto-antibodies,TA-Ab),并追踪随访至妊娠结束570例。根据TSH的水平分成3组:TSH减低组12例(TSH0.1 ml U/L)、TSH正常组270例(0.1ml U/L≤TSH2.5 m IU/L)和TSH增高组288例(TSH2.5 ml U/L)。根据甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和甲状腺球蛋白抗体(thyroglobulin antibody,Tg Ab)水平分为两组:TPOAb≥34IU/m L或Tg Ab≥115 IU/m L为TA-Ab阳性组(45例);TPOAb50 IU/m L且Tg Ab115 IU/m L为TA-Ab阴性组(525例)。评价不同甲状腺功能水平及甲功抗体情况对自然流产的影响及预测价值。结果 TSH增高组自然流产率(21.88%)显著高于TSH正常组(7.78%)(P0.05),其中亚临床甲状腺功能减退组孕妇自然流产率为20.21%,显著高于TSH正常组(P0.05)。TA-Ab阳性组自然流产率为66.67%,TA-Ab阴性组自然流产率为10.86%,差异有统计学意义(P0.05)。TSH增高伴TA-Ab阳性组自然流产率为71.43%,TSH正常组自然流产率为8.60%,差异有统计学意义(P0.05)。TA-Ab和TSH预测自然流产的ROC曲线下面积为0.657和0.714,对预测自然流产有统计学意义(P0.05)。结论妊娠早期孕妇TSH水平增高和TA-Ab阳性是妊娠期自然流产的危险因素,均是预测流产的重要指标,两者联合可能有更大的预测价值,因此妊娠早期甲状腺功能筛查应包括甲状腺功能(FT3,FT4,TSH)及甲功抗体(TA-Ab)检测。

The impact and predictive value of maternal thyroid function on spontaneous abortion in the first trimester of pregnancy

Objective To investigate the impact and predictive value of maternal thyroid diseases on spontaneous abortion in the first trimester of pregnancy. Methods A total of 621 women with the first trimester of pregnancy hospitalized in Sichuan Provincial Hospital for Women and Children from January to June 2014 were enrolled in this study,thyroid function and thyroid autoantibody were detected, including thyroid stimulating hormone(TSH), free thyroxine(FT4), free triiodothyronine(FT3) and thyroid auto-antibodies ( AT-Ab) , followed up to the end of pregnancy. According to the TSH level, divided them into three groups:TSH decreased group ( TSH < 0. 1 mlU/L ) , including 12 cases, TSH normal group ( 0. 1 mlU/L≤TSH <2. 5 mIU/L ) , including 270 cases, TSH increased group ( TSH>2. 5 mlU/L ) , including 288 cases. According to the TPOAb and TgAb level, divided them into two groups:TA-Ab positive group ( TPOAb≥34 IU/ml or TgAb≥115 IU/mL) ,including 45 cases, TA-Ab negative group ( TPOAb<50 IU/mL and TgAb<115 IU/mL), including 525 cases. Evaluated the impact and the predictive value of the different levels of thyroid function and thyroid antibody on spontaneous abortion. Results The rate of spontaneous abortion of the TSH increased group was up to 21. 88 % which was obvious higher than that of TSH normal group (P=0. 006). The rate of spontaneous abortion of TA-Ab positive group was 66. 67 %, TA-Ab negative group was 10. 88 %, the difference was statistically significant ( P =0. 000 ) . The rate of spontaneous abortion was 71. 43 % in the cases of both increased TSH and positive TA-Ab, and the rate was only 8. 60 % in the cases of normal TSH, the difference was statistically significant ( P =0. 000 ) . The area of ROC curve about TA-Ab and TSH prediction of spontaneous abortion was 0. 657 and 0. 714, the difference was statistically significant (P =0. 007, P =0. 000). Conclusion Serum TSH increased during the first trimester of pregnancy and positive thyroid autoantibody are both risk factors of spontaneous abortion, and are also useful indexes for predicting spontaneous abortion. Combination of thyroid autoantibody and TSH increase the predictive value, so thyroid function screening in the first trimester of pregnancy should include thyroid function ( FT3 , FT4 , TSH) and thyroid auto-antibodies ( TA-Ab) .