中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
11期
811-815
,共5页
周佳任%李威%杜鹃%乔宠%尚涛%刘学敏
週佳任%李威%杜鵑%喬寵%尚濤%劉學敏
주가임%리위%두견%교총%상도%류학민
先兆子痫%甲状腺功能减退症%甲状腺激素类%尿酸%肌酸酐
先兆子癇%甲狀腺功能減退癥%甲狀腺激素類%尿痠%肌痠酐
선조자간%갑상선공능감퇴증%갑상선격소류%뇨산%기산항
Pre-eclampsia%Hypothyroidism%Thyroid hormones%Uric acid%Creatinine
目的 探讨重度子痫前期孕妇合并不同程度的甲状腺功能减退症(甲减)对肾功能指标的影响及与甲状腺激素水平的相关性.方法 选择2011年5月至2013年3月在中国医科大学附属盛京医院住院并分娩的46例重度子痫前期合并亚临床甲减(亚甲减)孕妇为亚甲减组,23例重度子痫前期合并临床甲减孕妇为甲减组,109例促甲状腺激素(TSH)水平正常的重度子痫前期孕妇为单纯子痫前期组.检测各组孕妇的甲状腺激素水平和肾功能指标,对各组孕妇肾功能指标异常检出率进行相对风险度分析;对甲状腺激素水平与血清尿酸、尿素及肌酐的相关性进行分析.结果 (1)亚甲减组孕妇TSH水平为(6.1±3.2) mU/L,游离三碘甲状腺原氨酸(FT3)水平为(4.0±0.6)pmol/L,游离甲状腺素(FT4)水平为(11.8±1.5) pmol/L;甲减组孕妇TSH水平为(5.2±1.3)mU/L,FT3水平为(3.7±0.6) pmol/L,FT4水平为(9.3±0.5) pmol/L;单纯子痫前期组孕妇TSH水平为(1.9±0.8) mU/L,FT3水平为(4.0±0.8)pmol/L,FT4水平为(11.9±1.9) pmol/L.亚甲减组孕妇TSH水平明显高于单纯子痫前期组(P＜0.01);亚甲减组与甲减组比较,差异无统计学意义(P＞0.05);3组孕妇FT3水平分别比较,差异均无统计学意义(P＞0.05);甲减组孕妇FT4水平明显低于亚甲减组和单纯子痫前期组(P＜0.05).(2)甲减组孕妇血清尿酸、肌酐及尿素水平分别为(436±114)、(75± 15) μmol/L及(6±3) mmol/L,单纯子痫前期组孕妇分别为(378±114)、(65±22) μmol/L及(5±3) mmol/L,两组分别比较,差异均有统计学意义(P＜0.05);亚甲减组与甲减组比较,差异均无统计学意义(P＞0.05).(3)亚甲减组孕妇尿酸水平异常检出率(46％,21/46)显著高于甲减组(22％,5/23;P＜0.05).其余指标各组间分别比较,差异均无统计学意义(P＞0.05).(4)亚甲减组孕妇血清FT3水平与血清尿素、血清肌酐及血清尿酸水平均呈负相关(r=-0.32、-0.58、-0.35,P＜0.05);血清TSH和FT4水平与肾功能各项指标均无相关性(P＞0.05).甲减组孕妇FT3水平与血清肌酐水平呈负相关(r=-0.40,P＜O.05),与血清尿酸和尿素水平无相关性(P＞0.05);单纯子痫前期组孕妇TSH水平与血清肌酐水平呈正相关性(r=0.20,P=0.04),与血清尿素水平无相关性(r=0.04,P=0.65),与血清尿酸水平无相关性(r=0.12,P=0.20).结论 重度子痫前期孕妇合并甲减或亚甲减可影响肾功能,合并甲减孕妇的血清尿酸、尿素和肌酐水平均明显高于TSH水平正常的单纯重度子痫前期者;重度子痫前期合并甲减或亚甲减孕妇血清FT3水平与肌酐水平呈负相关.密切监测重度子痫前期孕妇的甲状腺功能,可及时发现肾功能损害并治疗甲减.
目的 探討重度子癇前期孕婦閤併不同程度的甲狀腺功能減退癥(甲減)對腎功能指標的影響及與甲狀腺激素水平的相關性.方法 選擇2011年5月至2013年3月在中國醫科大學附屬盛京醫院住院併分娩的46例重度子癇前期閤併亞臨床甲減(亞甲減)孕婦為亞甲減組,23例重度子癇前期閤併臨床甲減孕婦為甲減組,109例促甲狀腺激素(TSH)水平正常的重度子癇前期孕婦為單純子癇前期組.檢測各組孕婦的甲狀腺激素水平和腎功能指標,對各組孕婦腎功能指標異常檢齣率進行相對風險度分析;對甲狀腺激素水平與血清尿痠、尿素及肌酐的相關性進行分析.結果 (1)亞甲減組孕婦TSH水平為(6.1±3.2) mU/L,遊離三碘甲狀腺原氨痠(FT3)水平為(4.0±0.6)pmol/L,遊離甲狀腺素(FT4)水平為(11.8±1.5) pmol/L;甲減組孕婦TSH水平為(5.2±1.3)mU/L,FT3水平為(3.7±0.6) pmol/L,FT4水平為(9.3±0.5) pmol/L;單純子癇前期組孕婦TSH水平為(1.9±0.8) mU/L,FT3水平為(4.0±0.8)pmol/L,FT4水平為(11.9±1.9) pmol/L.亞甲減組孕婦TSH水平明顯高于單純子癇前期組(P＜0.01);亞甲減組與甲減組比較,差異無統計學意義(P＞0.05);3組孕婦FT3水平分彆比較,差異均無統計學意義(P＞0.05);甲減組孕婦FT4水平明顯低于亞甲減組和單純子癇前期組(P＜0.05).(2)甲減組孕婦血清尿痠、肌酐及尿素水平分彆為(436±114)、(75± 15) μmol/L及(6±3) mmol/L,單純子癇前期組孕婦分彆為(378±114)、(65±22) μmol/L及(5±3) mmol/L,兩組分彆比較,差異均有統計學意義(P＜0.05);亞甲減組與甲減組比較,差異均無統計學意義(P＞0.05).(3)亞甲減組孕婦尿痠水平異常檢齣率(46％,21/46)顯著高于甲減組(22％,5/23;P＜0.05).其餘指標各組間分彆比較,差異均無統計學意義(P＞0.05).(4)亞甲減組孕婦血清FT3水平與血清尿素、血清肌酐及血清尿痠水平均呈負相關(r=-0.32、-0.58、-0.35,P＜0.05);血清TSH和FT4水平與腎功能各項指標均無相關性(P＞0.05).甲減組孕婦FT3水平與血清肌酐水平呈負相關(r=-0.40,P＜O.05),與血清尿痠和尿素水平無相關性(P＞0.05);單純子癇前期組孕婦TSH水平與血清肌酐水平呈正相關性(r=0.20,P=0.04),與血清尿素水平無相關性(r=0.04,P=0.65),與血清尿痠水平無相關性(r=0.12,P=0.20).結論 重度子癇前期孕婦閤併甲減或亞甲減可影響腎功能,閤併甲減孕婦的血清尿痠、尿素和肌酐水平均明顯高于TSH水平正常的單純重度子癇前期者;重度子癇前期閤併甲減或亞甲減孕婦血清FT3水平與肌酐水平呈負相關.密切鑑測重度子癇前期孕婦的甲狀腺功能,可及時髮現腎功能損害併治療甲減.
목적 탐토중도자간전기잉부합병불동정도적갑상선공능감퇴증(갑감)대신공능지표적영향급여갑상선격소수평적상관성.방법 선택2011년5월지2013년3월재중국의과대학부속성경의원주원병분면적46례중도자간전기합병아림상갑감(아갑감)잉부위아갑감조,23례중도자간전기합병림상갑감잉부위갑감조,109례촉갑상선격소(TSH)수평정상적중도자간전기잉부위단순자간전기조.검측각조잉부적갑상선격소수평화신공능지표,대각조잉부신공능지표이상검출솔진행상대풍험도분석;대갑상선격소수평여혈청뇨산、뇨소급기항적상관성진행분석.결과 (1)아갑감조잉부TSH수평위(6.1±3.2) mU/L,유리삼전갑상선원안산(FT3)수평위(4.0±0.6)pmol/L,유리갑상선소(FT4)수평위(11.8±1.5) pmol/L;갑감조잉부TSH수평위(5.2±1.3)mU/L,FT3수평위(3.7±0.6) pmol/L,FT4수평위(9.3±0.5) pmol/L;단순자간전기조잉부TSH수평위(1.9±0.8) mU/L,FT3수평위(4.0±0.8)pmol/L,FT4수평위(11.9±1.9) pmol/L.아갑감조잉부TSH수평명현고우단순자간전기조(P＜0.01);아갑감조여갑감조비교,차이무통계학의의(P＞0.05);3조잉부FT3수평분별비교,차이균무통계학의의(P＞0.05);갑감조잉부FT4수평명현저우아갑감조화단순자간전기조(P＜0.05).(2)갑감조잉부혈청뇨산、기항급뇨소수평분별위(436±114)、(75± 15) μmol/L급(6±3) mmol/L,단순자간전기조잉부분별위(378±114)、(65±22) μmol/L급(5±3) mmol/L,량조분별비교,차이균유통계학의의(P＜0.05);아갑감조여갑감조비교,차이균무통계학의의(P＞0.05).(3)아갑감조잉부뇨산수평이상검출솔(46％,21/46)현저고우갑감조(22％,5/23;P＜0.05).기여지표각조간분별비교,차이균무통계학의의(P＞0.05).(4)아갑감조잉부혈청FT3수평여혈청뇨소、혈청기항급혈청뇨산수평균정부상관(r=-0.32、-0.58、-0.35,P＜0.05);혈청TSH화FT4수평여신공능각항지표균무상관성(P＞0.05).갑감조잉부FT3수평여혈청기항수평정부상관(r=-0.40,P＜O.05),여혈청뇨산화뇨소수평무상관성(P＞0.05);단순자간전기조잉부TSH수평여혈청기항수평정정상관성(r=0.20,P=0.04),여혈청뇨소수평무상관성(r=0.04,P=0.65),여혈청뇨산수평무상관성(r=0.12,P=0.20).결론 중도자간전기잉부합병갑감혹아갑감가영향신공능,합병갑감잉부적혈청뇨산、뇨소화기항수평균명현고우TSH수평정상적단순중도자간전기자;중도자간전기합병갑감혹아갑감잉부혈청FT3수평여기항수평정부상관.밀절감측중도자간전기잉부적갑상선공능,가급시발현신공능손해병치료갑감.
Objective To study effects of different degree of hypothyroidism in severe preeclampsia (S-PE) pregnant women on renal function and the correlation between them.Methods 46 S-PE patients with subclinical hypothyroidism (SCH) registered for treatment in the Shengjing Hospital of China Medical University from May 2011 to March 2013 were selected into SCH group,and 23 S-PE with overt hypothyroidism (OH) were selected into OH group,and 109 S-PE with normal thyroid stimulating hormone (TSH) levels were selected into simple group.Thyroid hormone and kidney function tests were analyzed in pregnant women with S-PE.We made an analysis of the relative risk of the detection rate of abnormal renal function and also the relationship between the levels of thyroid hormone and serum uric acid,serum urea and creatinine in patients with S-PE.Results (1) In SCH group serum TSH was (6.1±3.2) mU/L,free triiodothyronine (FT3) was (4.0±0.6) pmol/L,free thyroxine (FT4) was (11.8± 1.5) pmol/L; in OH group serum TSH was (5.2± 1.3) mU/L,FT3 was (3.7±0.6) pmol/L,FT4 was (9.3±0.5) pmol/L; in simple S-PE group serum TSH was (1.9±0.8) mU/L,FT3 was (4.0±0.8) pmol/L and FT4 was (11.9±1.9) pmol/L.TSH in SCH group was significantly higher than that in simple S-PE group (P＞0.01),the difference of in SCH and OH group were not statistically significant (P＞0.05).The difference of FT3 in three groups were not statistically significant (P＜0.05) ;FT4 in OH group was significantly lower than thoes in SCH and simple groups (P＜0.05).(2)Serum uric acid,creatinine and urea levels in OH group was (436± 114),(75± 15) μmol/L and (6±3)mmol/L,in simple S-PE group they were (378± 114),(65 ±22) μmol/L and (5±3) mmol/L.In comparison,the differences was statistically significant(P＜0.05).The differences were not statistically significant in SCH and OH groups (P＞0.05).(3)The abnormal detection rate of uric acid was significantly higher in SCH than that in OH group [46％ (21/46) versus 22％ (5/23),OR=3.0,P＜0.05].The comparison of remaining index has no statistical significance(P＞0.05).(4)In SCH group there was a significant inverse correlation of serum FT3 with serum urea levels,serum creatinine and serum uric acid (r=-0.32,-0.58,-0.35,P＜0.05).There was not a correlation of serum TSH,FT4 with indicators of renal function (P＞0.05).In OH group there was a negative correlation between FT3 and serum creatinine concentrations (r=-0.40,P＜0.05).In OH group there was not a correlation of FT3 with serum uric acid and urea (P＞0.05).There was a positive correlation between TSH and serum creatinine in simple S-PE group (r=0.20,P=0.04).There was not a correlation between TSH and serum urea(r=0.04,P=0.65),and serum uric acid (r=0.12,P=0.20).Conclusions There was effect of different hypothyrosis state in pre-eclampsia patients on renal function.Serum uric acid,urea and creatinine concentrations in S-PE pregnant women with OH were significantly higher than those in simple S-PE group with normal TSH.There was a negative correlation between FT3 and serum creatinine in S-PE.Hence the thyroid function should be regularly monitored in S-PE patients to find damage of renal function and management hypothyrosis.
