CAJ | 학술논문

目的了解妊娠合并Graves病孕妇围产儿并发症以及与甲状腺功能和抗甲状腺药物（ anti-thyroid drugs ，ATDs）的关系，并观察对后代的长远影响。方法回顾性分析2003年1月至2009年2月在我院分娩的既往或妊娠期有Graves病的93例孕妇（病例组）围产儿并发症情况，与无Graves病对照组孕妇进行比较，分析妊娠期间甲状腺功能状态及ATDs对围产儿的影响，比较两组后代甲状腺功能、甲状腺自身抗体及生长的差异。结果病例组孕妇死胎、低出生体重儿、先天畸形的发生率均高于对照组孕妇（ P＜0.05）。FT4高于正常参考范围上限是病例组孕妇发生死胎（P＝0.04，OR＝9.33，95％ CI＝1.11～78.8）、低出生体重儿（P＝0.04，OR＝9.33，95％CI＝1.11～78.79）、先天畸形（P＝0.02，OR＝7.29，95％ CI＝1.48～35.92）的危险因素；服ATDs孕妇其围产儿死胎、先天畸形的发生率与对照组孕妇均无统计学差异。病例组后代FT3、FT4、TGAb、TPOAb水平明显高于对照组后代。结论妊娠合并Graves病围产儿死胎、低出生体重儿、先天畸形的风险明显增加，Graves病孕妇合理使用ATDs有利于减少围产儿并发症。妊娠合并Graves病孕妇的后代甲状腺自身免疫异常风险增加。
목적료해임신합병Graves병잉부위산인병발증이급여갑상선공능화항갑상선약물（ anti-thyroid drugs ，ATDs）적관계，병관찰대후대적장원영향。방법회고성분석2003년1월지2009년2월재아원분면적기왕혹임신기유Graves병적93례잉부（병례조）위산인병발증정황，여무Graves병대조조잉부진행비교，분석임신기간갑상선공능상태급ATDs대위산인적영향，비교량조후대갑상선공능、갑상선자신항체급생장적차이。결과병례조잉부사태、저출생체중인、선천기형적발생솔균고우대조조잉부（ P＜0.05）。FT4고우정상삼고범위상한시병례조잉부발생사태（P＝0.04，OR＝9.33，95％ CI＝1.11～78.8）、저출생체중인（P＝0.04，OR＝9.33，95％CI＝1.11～78.79）、선천기형（P＝0.02，OR＝7.29，95％ CI＝1.48～35.92）적위험인소；복ATDs잉부기위산인사태、선천기형적발생솔여대조조잉부균무통계학차이。병례조후대FT3、FT4、TGAb、TPOAb수평명현고우대조조후대。결론임신합병Graves병위산인사태、저출생체중인、선천기형적풍험명현증가，Graves병잉부합리사용ATDs유리우감소위산인병발증。임신합병Graves병잉부적후대갑상선자신면역이상풍험증가。
Objective To evaluate the effect of Graves disease ( GD) on pregnancy outcomes as well as the thyroid function and growth of their offspring ,and to analyze the relationships between fetal complications and mother thyroid function and the usages of antithyroid drugs ( ATDs) .Methods 93 pregnant women with GD before or during pregnancy and 90 pregnant women without GD in our hospital from Jan .2003 to Feb.2009 were analyzed retrospectively .The fetal complications were compared , and the effects of thyroid function and ATDs on fetal complications were analyzed .The offspring of those women were followed up and their thyroid function and growth were evaluated .Results The rates of stillbirth ,low birth weight infant and congenital malformation in the GD group were significantly higher than that in the control group ( P<0.05 ) .FT4 level beyond the normal range was the risk factor in the occurrence and development of stillbirth ,low birth weight infant and congenital malformation for the GD group .There was no statistical difference of stillbirth and congenital malformation between mothers taking ATDs or not use ATDs.The levels of FT3,FT4,TGAb,TPOAb in the offspring of GD mothers were significantly higher than those in the offspring of the control ( P<0.05 ) .Conclusions Pregnancy with GD increases the risk of stillbirth ,low birth weight infant and congenital malformation .ATDs usage do not increase the rate of fetal malformation and stillbirth in this study.Children of GD mothers are prone to be in higher risk of abnormal thyroid autoimmune status .