CAJ | 학술논문

目的对1组58例产后甲状腺炎(PPT)患者随访观察24个月,确定其持续性甲状腺功能减退(甲减)的发生率及与持续性甲减发生相关的临床和生化因素.方法本研究是在前期PPT患病率调查基础上进行的前瞻性研究.对58例PPT患者在产后12、18和24个月进行随访,询问临床症状、进行体格检查并留取空腹血清,以测定血清促甲状腺素(TSH)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体( TgAb),TSH异常者加测FT4、FT3和TSH受体抗体(TRAb).以50名健康产妇为对照.结果 58例PPT患者的随访率为91.4％ (n=53),产后24个月时持续性甲减的发生率为20.8％(n=11),对照组无甲减发生.甲状腺功能亢进(甲亢)甲减双相型PPT患者持续性甲减的发生率为26.7％ (4/15),甲减单相型PPT患者持续性甲减的发生率为63.6％ (7/11),而表现为甲亢单相型的27例PPT患者无1例发生持续性甲减.所有发生持续性甲减的PPT患者,在产后6个月时TSH水平均高于4.8mU/L,并且其分娩时和产后12个月时的TSH均显著高于仅发生一过性甲减的PPT患者(均P＜0.01).53例PPT患者产后12、18、24个月时TPOAb阳性率分别为56.6％、50.9％和52.8％,TgAb阳性率分别为35.8％、30.2％和30.2％,均显著高于对照组；临床PPT患者各月份TPOAb阳性率和滴度均高于亚临床PPT患者,其中产后18个月和24个月时点的比较差异有统计学意义(均P＜O.05).结论 20.8％的PPT患者在产后24个月时持续甲减,持续性甲减的发生与PPT的病程特点、分娩时及产后的TSH水平有关.
목적 대1조58례산후갑상선염(PPT)환자수방관찰24개월,학정기지속성갑상선공능감퇴(갑감)적발생솔급여지속성갑감발생상관적림상화생화인소.방법 본연구시재전기PPT환병솔조사기출상진행적전첨성연구.대58례PPT환자재산후12、18화24개월진행수방,순문림상증상、진행체격검사병류취공복혈청,이측정혈청촉갑상선소(TSH)、항갑상선과양화물매항체(TPOAb)、항갑상선구단백항체( TgAb),TSH이상자가측FT4、FT3화TSH수체항체(TRAb).이50명건강산부위대조.결과 58례PPT환자적수방솔위91.4％ (n=53),산후24개월시지속성갑감적발생솔위20.8％(n=11),대조조무갑감발생.갑상선공능항진(갑항)갑감쌍상형PPT환자지속성갑감적발생솔위26.7％ (4/15),갑감단상형PPT환자지속성갑감적발생솔위63.6％ (7/11),이표현위갑항단상형적27례PPT환자무1례발생지속성갑감.소유발생지속성갑감적PPT환자,재산후6개월시TSH수평균고우4.8mU/L,병차기분면시화산후12개월시적TSH균현저고우부발생일과성갑감적PPT환자(균P＜0.01).53례PPT환자산후12、18、24개월시TPOAb양성솔분별위56.6％、50.9％화52.8％,TgAb양성솔분별위35.8％、30.2％화30.2％,균현저고우대조조；림상PPT환자각월빈TPOAb양성솔화적도균고우아림상PPT환자,기중산후18개월화24개월시점적비교차이유통계학의의(균P＜O.05).결론 20.8％적PPT환자재산후24개월시지속갑감,지속성갑감적발생여PPT적병정특점、분면시급산후적TSH수평유관.
Objective To investigate the cumulative incidence of persistent hypothyroidism in patients who were diagnosed as postpartum thyroiditis ( PPT),and to determine the factors associated with the development of persistent hypothyroidism in those patients.Methods The present study was performed as the continuous study followed by the former epidemiological survey on PPT,in which 58 patients with PPT (35 overt PPT and 23 subclinical PPT) were diagnosed.The 58 patients were followed up at 12th month postpartum,and then for every 6 months until 24 months postpartum.Fasting blood samples were taken for testing serum TSH,thyroid peroxidase antibody ( TPOAb),and thyroglobulin antibody ( TgAb ).Free T3 ( FT3 ),free T4 ( FT4 ),and TSH receptor antibody ( TRAh ) were detected if TSH was abnormal.50 healthy postpartum women were used as control group.Results Of the total 58 PPT patients,91,4％ ( n =53 ) were successfully followed.Five patients with overt PPT and 6 patients with subclinical PPT developed persistent hypothyroidism,and the cumulative incidence of persistent hypothyroidism in the studied PPT patients was 20.8％.Among 15 PPT patients who had a classical biphasic course (a thyrotoxic phase followed by a hypothyroid phase),persistent hypothyroidism was seen in 26.7％ (n =4 ).Among 11 PPT patients with hypothyroidism only,persistent hypothyroidism was seen in 63.6％ ( n =7).On the contrary,none of the patients with thyrotoxicosis only had persistent hypothyroidism.All of the patients who developed persistent hypothyrodism had a higher TSH levels than 4.8 mU/L at 6th month postpartum.Before delivery,TSH levels of the patients developed persistent hypothyroidism were significantly higher than those of the patients with transient hypothyroidism,and this was the case at the 12th month postpartum ( all P＜0.01 ).PPT patients maintained a relatively higher rate of thyroid autoantibodies.The positive rate of TPOAb at the 12th,18th,and 24th month postpartum was 56.6％,50.9％,and 52.8％,respectively; and the positive rate of TgAb being 35.8％,30.2％,and 30.2％,respectively.Both the positive rate and titer of TPOAb in patients with overt PPT were higher than those in patients with subclinical PPT at the 18th and 24th month postpartum (P＜0.05).Conclusions 20.8％ patients with PPT developed persistent hypothyroidism at the 24th month postpartum.Whether a patient with PPT would develop persistent hypothyroidism depends on his clinical feature and TSH level.