妊娠一过性甲状腺毒症的临床研究
임신일과성갑상선독증적림상연구
A clinical study on gestational transient thyrotoxicosis
  • 万方数据
    中华内科杂志 중화내과잡지
    CHINESE JOURNAL OF INTERNAL MEDICINE
    2008年 12期 1003-1007 ,共5页

    温滨红%滕卫平%单忠艳%李元宾%李佳%高波%尚涛%周佳任%李晨阳%周卫卫%丁彬%马英%武英%刘群%刘伟%于晓会%陈彦彦%王薇薇%范晨玲%王红%郭锐

    온빈홍%등위평%단충염%리원빈%리가%고파%상도%주가임%리신양%주위위%정빈%마영%무영%류군%류위%우효회%진언언%왕미미%범신령%왕홍%곽예

    甲状腺毒症%妊娠初期%绒毛膜促性腺激素 甲狀腺毒癥%妊娠初期%絨毛膜促性腺激素
    갑상선독증%임신초기%융모막촉성선격소
    Thyrotoxicosis%Pregnancy trimester,first%Chorionic gonadotropin
    目的 调查沈阳地区既往健康的妇女妊娠早期妊娠一过性甲状腺毒症(GTT)的患病率及其病因.方法 对来自沈阳地区10家医院的534例妊娠早期妇女进行问卷调查、体格检查、血清促甲状腺素(TSH)、游离T4(FT4)、游离T3(FT3)、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺素受体抗体(TRAb)和人绒毛膜促性腺激素(hCG)水平的检测.结果 (1)妊娠早期甲状腺毒症总患病率为9.75%,GTT的患病率为7.86%,占甲状腺毒症的80.77%;88.89%临床GTT表现为单纯FT3升高.(2)妊娠6、8～10和12周孕妇血清hCG水平逐渐升高,中位数分别为25300、85220和81780IU/L(P=0.000).血清TSH中位数依次降低(P＜0.01),分别为1.45、1.10和0.84mIU/L.(3)当妊娠妇女血清hCG水平＞50 000 IU/L时,GTT的比例明显升高;当血清hCG水平在80 000～110000IU/L时发生亚临床GTT的比例明显升高;当血清hCG水平＞110 000IU/L时发生临床CTT的比例明显升高.相关分析结果 显示,妊娠早期血清hCG与TSH显著负相关(r=-0.402,P=0.000),与FT3正相关(r=0.165,P=0.000),而与FT4无相关.结论 GTT是妊娠早期甲状腺功能亢进症的首要病因,占妊娠早期甲状腺毒症的80.77%,其血清学特点主要表现为血清FTT升高.妊娠早期血清hCG水平与GTT严重程度相关.
    목적 조사침양지구기왕건강적부녀임신조기임신일과성갑상선독증(GTT)적환병솔급기병인.방법 대래자침양지구10가의원적534례임신조기부녀진행문권조사、체격검사、혈청촉갑상선소(TSH)、유리T4(FT4)、유리T3(FT3)、갑상선과양화물매항체(TPOAb)、촉갑상선소수체항체(TRAb)화인융모막촉성선격소(hCG)수평적검측.결과 (1)임신조기갑상선독증총환병솔위9.75%,GTT적환병솔위7.86%,점갑상선독증적80.77%;88.89%림상GTT표현위단순FT3승고.(2)임신6、8～10화12주잉부혈청hCG수평축점승고,중위수분별위25300、85220화81780IU/L(P=0.000).혈청TSH중위수의차강저(P＜0.01),분별위1.45、1.10화0.84mIU/L.(3)당임신부녀혈청hCG수평＞50 000 IU/L시,GTT적비례명현승고;당혈청hCG수평재80 000～110000IU/L시발생아림상GTT적비례명현승고;당혈청hCG수평＞110 000IU/L시발생림상CTT적비례명현승고.상관분석결과 현시,임신조기혈청hCG여TSH현저부상관(r=-0.402,P=0.000),여FT3정상관(r=0.165,P=0.000),이여FT4무상관.결론 GTT시임신조기갑상선공능항진증적수요병인,점임신조기갑상선독증적80.77%,기혈청학특점주요표현위혈청FTT승고.임신조기혈청hCG수평여GTT엄중정도상관.
    Objective To investigate the prevalence of gestational transient thyrotoxicosis(GTT) and analyze the cause of thyrotoxicosis encountered in this period MethodsAn epidemiologic survey in ten hospitals in Shenyang was performed and 534 pregnant women during the first trimester of pregnancy filled questionaire,received physical examination and had serum thyroid-stimulating hormone(TSH),free T4 (FT4),free T3(FT3),thyroid peroxjdase antibody(TPOAb),thyrotrophin receptor antibody(TRAb),and human chorionic gonadotrophin(hCG)tests.Results(1)The total prevalence of thyrotoxicosis was 9.75%(52/534)in the first trimester and the prevalence of Grrr was 7.86%.which accounted for 80.77%of the thyroxicosis encountered in this period.A total of 88.89%of the overt GTT showed only elevated FT3 level.(2)The level of serum hCG increased gradually in the first trimester.The medians of hCG were 25 300,85 220 and 81 780 IU/L 6,8-10 and 12 weeks after gestation.respectively(P=0.000).The medians of serum TSH were 1.45.1.10 and 0.84 mlU/I,6.8-10 and 12 weeks after gestation,respectively(P＜0.01).(3)When segum hCG was more than 50 000 IU/L,the prevalece of GTT increased obviously.When serum hCG was between 80000 IU/L and 110000 IU/L,subclinical GTT increased significantly.When serum hCG was more than 110000 IU/L,overt GTT increased significantly.Correlation analysis showed that serum hCG was related negatively with TSH(r=-0.402,P=0.000)and positively with FT3(r=0.165,P=0.000),but not related with FT4.Conclusions The prevalence of GTT is 7.86%in the first trimester and it is the main cause of thyrotoxicosis found in the first trimester,accounting for 80.77%of all the causes.The serological characteristic of overt GTT is mainly the elevation of serum FT3 leveL Serum hCG level is related with the severity of GTT.
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