CAJ | 학술논문

目的探讨甲状腺自身抗体阳性妇女孕期甲状腺功能干预对婴儿甲状腺功能的影响.方法选择产前检查发现的甲状腺过氧化物酶抗体(TPOAb)和(或)甲状腺球蛋白抗体(TgAb)阳性妊娠妇女55例.随机分为干预组(子代为A)36例和非干预组(子代为B)19例,设同期自身抗体阴性对照组(子代为N)30例.选择左旋甲状腺素片作为干预制剂.采用化学发光酶免疫分析法测定3组入选后和分娩前空腹血清TPOAb、TgAb、TSH、TT3、TT4、FT3、FT4水平,同时测定母体尿碘含量.新生儿出生后测定脐血、出生后3～4周及8～10周静脉血TSH、TT3、TT4、FT3、FT4水平.结果干预组、非干预组母体基线血清TSH水平显著高于对照组(P＜0.05).分娩前非干预组与另两组比较,血清TSH增高和TT3、TT4、FT4降低具有统计学差异(P＜0.05或P＜0.01).胎儿出生后脐血TSH水平在B组(7.06±1.31)mIU/L和A组(6.23±1.26)mIU/L均显著高于N组(5.48±1.17)mIU/L(P＜0.01或P＜0.05).出生3～4周新生儿B组血清TSH(3.21±0.70)mIU/L高于N组[(2.72±0.51)mIU/L]和A组[(2.78±0.42)mIU/L,均P＜0.05].出生8～10周婴儿B组血清TSH[(2.99±0.57)mIU/L]高于N组[(2.48±0.68)mIU/L,P＜0.05].多元逐步回归分析,母体TSH、TPOAb及尿碘含量与婴儿TSH独立相关.结论不同甲状腺功能状态的妊娠妇女,其子代出生后的甲状腺功能存在差异.胎儿出生后甲状腺功能与母亲甲状腺自身抗体及孕期甲状腺功能状态有关.
목적 탐토갑상선자신항체양성부녀잉기갑상선공능간예대영인갑상선공능적영향.방법선택산전검사발현적갑상선과양화물매항체(TPOAb)화(혹)갑상선구단백항체(TgAb)양성임신부녀55례.수궤분위간예조(자대위A)36례화비간예조(자대위B)19례,설동기자신항체음성대조조(자대위N)30례.선택좌선갑상선소편작위간예제제.채용화학발광매면역분석법측정3조입선후화분면전공복혈청TPOAb、TgAb、TSH、TT3、TT4、FT3、FT4수평,동시측정모체뇨전함량.신생인출생후측정제혈、출생후3～4주급8～10주정맥혈TSH、TT3、TT4、FT3、FT4수평.결과간예조、비간예조모체기선혈청TSH수평현저고우대조조(P＜0.05).분면전비간예조여령량조비교,혈청TSH증고화TT3、TT4、FT4강저구유통계학차이(P＜0.05혹P＜0.01).태인출생후제혈TSH수평재B조(7.06±1.31)mIU/L화A조(6.23±1.26)mIU/L균현저고우N조(5.48±1.17)mIU/L(P＜0.01혹P＜0.05).출생3～4주신생인B조혈청TSH(3.21±0.70)mIU/L고우N조[(2.72±0.51)mIU/L]화A조[(2.78±0.42)mIU/L,균P＜0.05].출생8～10주영인B조혈청TSH[(2.99±0.57)mIU/L]고우N조[(2.48±0.68)mIU/L,P＜0.05].다원축보회귀분석,모체TSH、TPOAb급뇨전함량여영인TSH독립상관.결론불동갑상선공능상태적임신부녀,기자대출생후적갑상선공능존재차이.태인출생후갑상선공능여모친갑상선자신항체급잉기갑상선공능상태유관.
Objective To study influences of intervention in pregnant women with positive thyroid autoantibodies on the thyroid function of babies. Methods A total of 55 pregnant women were enrolled with positive thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) during prenatal checkup. They were randomly divided into two groups: intervening group( n= 36, newborn group A) was treated with levothyroxine ( L-T4 ), and non-intervening group ( n= 19, newborn group B) was not treated. 30 cases of pregnant women with negative thyroid autoantibodies served as a normal population control group (newborn group N). Serum TSH, TPOAb, TgAb, TT3, TT4, FT3 and FT4 were measured by high-sensitive immunochemiluminescent assay ,and urinary iodine was also examined in the pregnant women. Fetal plasma TSH, TT3, TT4, FT3, and FT4 levels were measured after cutting the umbilical cord from placenta, and repeated measurements were made by 3-4 weeks and 8-10 weeks postpartum. Results At baseline, serum TSH levels of the pregnant women in intervening and nonintervening groups were significantly higher than that in control group ( P＜0.05 ). Non-intervening group had higher TSH and lower TT3, TT4, FT4 compared with the other two groups (P＜0. 05 or P＜0.01 ). The cord blood TSH levels of the neonates in both group B [(7.06 ± 1.31 ) mIU/L] and group A [(6.23 ± 1.26 ) mIU/L] were significantly higher than that of group N [(5.48±1. 17) mIU/L, P＜0.01 and 0. 05]. By 3-4 weeks postpartum,the serum TSH level [(3.21±0.70)mIU/L] in group B was significantly higher than those in group N [(2.72±0.51)mIU/L] and group A [(2.78±0.42) mIU/L, all P＜0.05]. The serum TSH level in group B [(2.99±0.57) mIU/L] was still higher than those in group N [(2.48±0.68) mIU/L] by 8 to 10 weeks postpartum (P＜0.05 ). Multiple stepwise regression analysis revealed that TSH, TPOAb, and urine iodine levels of mothers were independently related to TSH of their infants. Conclusion When differences in thyroid function exist in pregnant women, these differences also reside in their offspring. The thyroid function in neonates correlates with both the thyroid autoantibodies and thyroid function of their mothers.