目的 探讨不同促甲状腺激素(TSH)标准诊断的妊娠早期亚临床甲状腺功能减退症(亚甲减)及甲状腺过氧化物酶抗体(TPO-Ab)阳性对妊娠的影响.方法 采用前瞻性研究的方法,收集2011年8月至2013年2月在陕西省妇幼保健院产科首次产检并分娩的孕妇3 244例.按美国甲状腺协会标准,以血清TSH水平＞2.50 mU/L、血清游离甲状腺素(FT4)水平正常的妊娠合并亚甲减孕妇为国外标准组;按照2012年国内制定的《妊娠和产后甲状腺疾病诊治指南》标准,以血清TSH水平＞5.76 mU/L、血清FT4水平正常的妊娠合并亚甲减孕妇为国内标准组;TSH水平介于2.50～5.76 mU/L之间的妊娠合并亚甲减孕妇为研究观察组;选择TSH水平＜2.50 mU/L,且TPO-Ab检查结果阴性的健康孕妇作为对照组.对各组孕妇的TPO-Ab阳性检查结果及其与妊娠结局及并发症进行分析.结果 (1)国外标准组亚甲减孕妇共635例,发生率为19.57％(635/3 244).国内标准组亚甲减孕妇共70例,发生率为2.16％(70/3 244).两组亚甲减发生率比较,差异有统计学意义(P＜0.01).研究观察组亚甲减孕妇共565例,发生率为17.42％(565/3 244),与国内标准组的亚甲减发生率比较,差异有统计学意义(P＜0.01);与国外标准组的亚甲减发生率比较,差异无统计学意义(P＞0.05).(2)3 244例孕妇中TPO-Ab阳性402例,阴性2 842例.其中,国外标准组阳性318例,阳性孕妇的亚甲减发生率为79.10％(318/402);阴性317例,阴性孕妇的亚甲减发生率为11.15％(317/2 842),两者发生率比较,差异有统计学意义(P＜0.01).国内标准组阳性孕妇46例,阳性孕妇的亚甲减发生率为11.44％(46/402);阴性24例,阴性孕妇的亚甲减发生率为0.84％ (24/2 842),两者发生率比较,差异有统计学意义(P＜0.01).研究观察组阳性孕妇272例,阳性孕妇的亚甲减发生率为67.66％(272/402);阴性293例,阴性孕妇的亚甲减发生率为10.31％(293/2 842),两者发生率比较,差异有统计学意义(P＜0.01).(3)国外标准组孕妇流产、早产、妊娠期高血压疾病、妊娠期糖尿病(GDM)等的发生率分别与对照组比较,差异均有统计学意义(P＜0.05);胎盘早剥、胎儿窘迫发生率比较,差异均无统计学意义(P＞0.05).国内标准组孕妇流产、早产、妊娠期高血压疾病、GDM等的发生率分别与对照组比较,差异均有统计学意义(P＜0.05);胎盘早剥、胎儿窘迫发生率比较,差异均无统计学意义(P＞0.05).研究观察组孕妇流产、妊娠期高血压疾病、GDM等的发生率分别与对照组比较,差异均有统计学意义(P＜0.05);早产、胎盘早剥及胎儿窘迫的发生率比较,差异均无统计学意义(P＞0.05).(4)国外标准组TPO-Ab阳性孕妇流产、早产、胎盘早剥、妊娠合并贫血、胎儿窘迫的发生率分别与TPO-Ab阴性孕妇比较,差异均无统计学意义(P＞0.05);但两者的妊娠期高血压疾病、GDM的发生率比较,差异均有统计学意义(P＜0.05).国内标准组TPO-Ab阳性孕妇流产、早产、妊娠期高血压疾病、GDM、胎盘早剥、胎儿窘迫的发生率与TPO-Ab阴性孕妇比较,呈增高趋势,但分别比较,差异均无统计学意义(P＞0.05).研究观察组TPO-Ab阳性孕妇妊娠期高血压疾病、GDM的发生率与TPO-Ab阴性孕妇比较,差异均有统计学意义(P＜0.05);而流产、早产、胎盘早剥、胎儿窘迫的发生率比较,差异均无统计学意义(P＞0.05).结论 (1)妊娠早期亚甲减孕妇患病率较高,且可导致不良妊娠结局增加;(2)TPO-Ab阳性对预测甲状腺功能异常和GDM发病风险具有重要的临床意义;(3)相对比较,按我国2012年标准(血清TSH水平＞5.76mU/L)诊断亚甲减可能过于谨慎,不利于孕期管理;按美国标准(血清TSH水平＞2.5 mU/L)诊断亚甲减对孕期管理更加安全,以获得更良好的妊娠结局.
目的 探討不同促甲狀腺激素(TSH)標準診斷的妊娠早期亞臨床甲狀腺功能減退癥(亞甲減)及甲狀腺過氧化物酶抗體(TPO-Ab)暘性對妊娠的影響.方法 採用前瞻性研究的方法,收集2011年8月至2013年2月在陝西省婦幼保健院產科首次產檢併分娩的孕婦3 244例.按美國甲狀腺協會標準,以血清TSH水平＞2.50 mU/L、血清遊離甲狀腺素(FT4)水平正常的妊娠閤併亞甲減孕婦為國外標準組;按照2012年國內製定的《妊娠和產後甲狀腺疾病診治指南》標準,以血清TSH水平＞5.76 mU/L、血清FT4水平正常的妊娠閤併亞甲減孕婦為國內標準組;TSH水平介于2.50～5.76 mU/L之間的妊娠閤併亞甲減孕婦為研究觀察組;選擇TSH水平＜2.50 mU/L,且TPO-Ab檢查結果陰性的健康孕婦作為對照組.對各組孕婦的TPO-Ab暘性檢查結果及其與妊娠結跼及併髮癥進行分析.結果 (1)國外標準組亞甲減孕婦共635例,髮生率為19.57％(635/3 244).國內標準組亞甲減孕婦共70例,髮生率為2.16％(70/3 244).兩組亞甲減髮生率比較,差異有統計學意義(P＜0.01).研究觀察組亞甲減孕婦共565例,髮生率為17.42％(565/3 244),與國內標準組的亞甲減髮生率比較,差異有統計學意義(P＜0.01);與國外標準組的亞甲減髮生率比較,差異無統計學意義(P＞0.05).(2)3 244例孕婦中TPO-Ab暘性402例,陰性2 842例.其中,國外標準組暘性318例,暘性孕婦的亞甲減髮生率為79.10％(318/402);陰性317例,陰性孕婦的亞甲減髮生率為11.15％(317/2 842),兩者髮生率比較,差異有統計學意義(P＜0.01).國內標準組暘性孕婦46例,暘性孕婦的亞甲減髮生率為11.44％(46/402);陰性24例,陰性孕婦的亞甲減髮生率為0.84％ (24/2 842),兩者髮生率比較,差異有統計學意義(P＜0.01).研究觀察組暘性孕婦272例,暘性孕婦的亞甲減髮生率為67.66％(272/402);陰性293例,陰性孕婦的亞甲減髮生率為10.31％(293/2 842),兩者髮生率比較,差異有統計學意義(P＜0.01).(3)國外標準組孕婦流產、早產、妊娠期高血壓疾病、妊娠期糖尿病(GDM)等的髮生率分彆與對照組比較,差異均有統計學意義(P＜0.05);胎盤早剝、胎兒窘迫髮生率比較,差異均無統計學意義(P＞0.05).國內標準組孕婦流產、早產、妊娠期高血壓疾病、GDM等的髮生率分彆與對照組比較,差異均有統計學意義(P＜0.05);胎盤早剝、胎兒窘迫髮生率比較,差異均無統計學意義(P＞0.05).研究觀察組孕婦流產、妊娠期高血壓疾病、GDM等的髮生率分彆與對照組比較,差異均有統計學意義(P＜0.05);早產、胎盤早剝及胎兒窘迫的髮生率比較,差異均無統計學意義(P＞0.05).(4)國外標準組TPO-Ab暘性孕婦流產、早產、胎盤早剝、妊娠閤併貧血、胎兒窘迫的髮生率分彆與TPO-Ab陰性孕婦比較,差異均無統計學意義(P＞0.05);但兩者的妊娠期高血壓疾病、GDM的髮生率比較,差異均有統計學意義(P＜0.05).國內標準組TPO-Ab暘性孕婦流產、早產、妊娠期高血壓疾病、GDM、胎盤早剝、胎兒窘迫的髮生率與TPO-Ab陰性孕婦比較,呈增高趨勢,但分彆比較,差異均無統計學意義(P＞0.05).研究觀察組TPO-Ab暘性孕婦妊娠期高血壓疾病、GDM的髮生率與TPO-Ab陰性孕婦比較,差異均有統計學意義(P＜0.05);而流產、早產、胎盤早剝、胎兒窘迫的髮生率比較,差異均無統計學意義(P＞0.05).結論 (1)妊娠早期亞甲減孕婦患病率較高,且可導緻不良妊娠結跼增加;(2)TPO-Ab暘性對預測甲狀腺功能異常和GDM髮病風險具有重要的臨床意義;(3)相對比較,按我國2012年標準(血清TSH水平＞5.76mU/L)診斷亞甲減可能過于謹慎,不利于孕期管理;按美國標準(血清TSH水平＞2.5 mU/L)診斷亞甲減對孕期管理更加安全,以穫得更良好的妊娠結跼.
목적 탐토불동촉갑상선격소(TSH)표준진단적임신조기아림상갑상선공능감퇴증(아갑감)급갑상선과양화물매항체(TPO-Ab)양성대임신적영향.방법 채용전첨성연구적방법,수집2011년8월지2013년2월재합서성부유보건원산과수차산검병분면적잉부3 244례.안미국갑상선협회표준,이혈청TSH수평＞2.50 mU/L、혈청유리갑상선소(FT4)수평정상적임신합병아갑감잉부위국외표준조;안조2012년국내제정적《임신화산후갑상선질병진치지남》표준,이혈청TSH수평＞5.76 mU/L、혈청FT4수평정상적임신합병아갑감잉부위국내표준조;TSH수평개우2.50～5.76 mU/L지간적임신합병아갑감잉부위연구관찰조;선택TSH수평＜2.50 mU/L,차TPO-Ab검사결과음성적건강잉부작위대조조.대각조잉부적TPO-Ab양성검사결과급기여임신결국급병발증진행분석.결과 (1)국외표준조아갑감잉부공635례,발생솔위19.57％(635/3 244).국내표준조아갑감잉부공70례,발생솔위2.16％(70/3 244).량조아갑감발생솔비교,차이유통계학의의(P＜0.01).연구관찰조아갑감잉부공565례,발생솔위17.42％(565/3 244),여국내표준조적아갑감발생솔비교,차이유통계학의의(P＜0.01);여국외표준조적아갑감발생솔비교,차이무통계학의의(P＞0.05).(2)3 244례잉부중TPO-Ab양성402례,음성2 842례.기중,국외표준조양성318례,양성잉부적아갑감발생솔위79.10％(318/402);음성317례,음성잉부적아갑감발생솔위11.15％(317/2 842),량자발생솔비교,차이유통계학의의(P＜0.01).국내표준조양성잉부46례,양성잉부적아갑감발생솔위11.44％(46/402);음성24례,음성잉부적아갑감발생솔위0.84％ (24/2 842),량자발생솔비교,차이유통계학의의(P＜0.01).연구관찰조양성잉부272례,양성잉부적아갑감발생솔위67.66％(272/402);음성293례,음성잉부적아갑감발생솔위10.31％(293/2 842),량자발생솔비교,차이유통계학의의(P＜0.01).(3)국외표준조잉부유산、조산、임신기고혈압질병、임신기당뇨병(GDM)등적발생솔분별여대조조비교,차이균유통계학의의(P＜0.05);태반조박、태인군박발생솔비교,차이균무통계학의의(P＞0.05).국내표준조잉부유산、조산、임신기고혈압질병、GDM등적발생솔분별여대조조비교,차이균유통계학의의(P＜0.05);태반조박、태인군박발생솔비교,차이균무통계학의의(P＞0.05).연구관찰조잉부유산、임신기고혈압질병、GDM등적발생솔분별여대조조비교,차이균유통계학의의(P＜0.05);조산、태반조박급태인군박적발생솔비교,차이균무통계학의의(P＞0.05).(4)국외표준조TPO-Ab양성잉부유산、조산、태반조박、임신합병빈혈、태인군박적발생솔분별여TPO-Ab음성잉부비교,차이균무통계학의의(P＞0.05);단량자적임신기고혈압질병、GDM적발생솔비교,차이균유통계학의의(P＜0.05).국내표준조TPO-Ab양성잉부유산、조산、임신기고혈압질병、GDM、태반조박、태인군박적발생솔여TPO-Ab음성잉부비교,정증고추세,단분별비교,차이균무통계학의의(P＞0.05).연구관찰조TPO-Ab양성잉부임신기고혈압질병、GDM적발생솔여TPO-Ab음성잉부비교,차이균유통계학의의(P＜0.05);이유산、조산、태반조박、태인군박적발생솔비교,차이균무통계학의의(P＞0.05).결론 (1)임신조기아갑감잉부환병솔교고,차가도치불량임신결국증가;(2)TPO-Ab양성대예측갑상선공능이상화GDM발병풍험구유중요적림상의의;(3)상대비교,안아국2012년표준(혈청TSH수평＞5.76mU/L)진단아갑감가능과우근신,불리우잉기관리;안미국표준(혈청TSH수평＞2.5 mU/L)진단아갑감대잉기관리경가안전,이획득경량호적임신결국.
Objective To explore the effect of different diagnositic criteria of subclinical hypothyroidism using thyroid stimulating hormone (TSH) and positive thyroid peroxidase antibodies (TPO-Ab) on the pregnancy outcomes.Methods 3 244 pregnant women who had their antenatal care and delivered in Child and Maternity Health Hospital of Shannxi Province August from 2011 to February 2013 were recruited prospectively.According to the standard of American Thyroid Association (ATA),pregnant women with normal serum free thyroxine (FT4) whose serum TSH level＞ 2.50 mU/L were diagnosed as subclinical hypothyroidism in pregnancy (foreign standard group).According to the Guideline of Diagnosis and Therapy of Prenatal and Postpartum Thyroid Disease made by Chinese Society of Endocrinology and Chinese Society of Perinatal Medicine in 2012,pregnant women with serum TSH level＞ 5.76 mU/L,and normal FT4 were diagnosed as subclinical hypothyroidism in pregnancy(national standard group).Pregnant women with subclinical hypothyroidism whose serum TSH levels were between 2.50-5.76 mU/L were referred as the study observed group; and pregnant women with serum TSH level＜ 2.50 mU/L and negative TPO-Ab were referred as the control group.Positive TPO-Ab results and the pregnancy outcomes were analyzed.Results (1) There were 635 cases in the foreign standard group,with the incidence of 19.57％ (635/3 244).And there were 70 cases in the national standard group,with the incidence of 2.16％ (70/3 244).There were statistically significant difference between the two groups (P＜0.01).There were 565 cases in the study observed group,with the incidence of 17.42％ (565/3 244).There was statistically significant difference(P＜0.01) when compared with the national standard group; while there was no statistically significant difference (P＞0.05) when compared with the foreign standard group.(2) Among the 3 244 cases,402 cases had positive TPO-Ab.318 positive cases were in the foreign standard group,and the incidence of subclinical hypothyroidism was 79.10％ (318/402).There were 317 negative cases in the foreign standard group,with the incidence of 11.15％ (317/2 842).The difference was statistically significant (P＜0.01) between them.In the national standard group,46 cases had positive TPO-Ab,with the incidence of 11.44％ (46/402),and 24 cases had negative result,with the incidence of 0.84％ (24/2 842).There were statistically significant difference (P＜0.01) between them.In the study observed group,272 cases were TPO-Ab positive,with the incidence of 67.66％ (272/402),and 293 cases were negative,with the incidence of 10.31％ (293/2 842),the difference was statistically significant (P＜0.01).(3) The incidence of miscarriage,premature delivery,gestational hypertension disease,gestational diabetes mellitus (GDM) in the foreign standard group had statistically significant differences (P＜0.05) when compared with the control group,respectively.While there was no statistically significant difference (P＞0.05) in the incidence of placental abruption or fetal distress.And the incidence of miscarriage,premature delivery,gestational hypertension disease,GDM in the national standard group had statistical significant difference (P＜0.05) compared with the control group,respectively.While there was no statistically significant difference (P＞0.05) in the incidence of placental abruption or fetal distress.This study observed group of pregnant women's abortion,gestational hypertension disease,GDM incidence respectively compared with control group,the difference had statistical significance (P＜0.05); but in preterm labor,placental abruption,and fetal distress incidence,there were no statistically significant difference (P＞0.05).(4) The incidence of miscarriage,premature delivery,gestational hypertension disease,GDM,placental abruption,fetal distress in the TPO-Ab positive cases of the national standard group showed an increase trend when compared with TPO-Ab negative cases,with no statistically significant difference (P＞0.05).The incidence of gestational hypertension disease and GDM in the TPO-Ab positive cases of the study observed group had statistical significance difference (P＜0.05) when compared with TPO-Ab negative cases; while the incidence of miscarriage,premature birth,placental abruption,fetal distress had no statistically significant difference (P＞0.05).The incidence of gestational hypertension disease and GDM in the TPO-Ab positive cases had statistically significance difference when compared with TPO-Ab negtive cases of foreign standard group (P＜0.05).Conclusions (1) The incidence of subclinical hypothyroidism is rather high during early pregnancy and can lead to adverse pregnancy outcome.(2) Positive TPO-Ab result has important predictive value of the thyroid dysfunction and GDM.(3) Relatively,the ATA standard of diagnosis (serum TSH level＞ 2.50 mU/L) is safer for the antenatal care; the national standard (serum TSH level＞ 5.76 mU/L) is not conducive to pregnancy management.
