中国医科大学学报
中國醫科大學學報
중국의과대학학보
JOURNAL OF CHINA MEDICAL UNIVERSITY
2014年
5期
418-421,425
,共5页
周佳任%杜鹃%乔宠%尚涛%马冰
週佳任%杜鵑%喬寵%尚濤%馬冰
주가임%두견%교총%상도%마빙
先兆子痫%甲状腺功能减退%甲状腺激素%24 h尿蛋白定量
先兆子癇%甲狀腺功能減退%甲狀腺激素%24 h尿蛋白定量
선조자간%갑상선공능감퇴%갑상선격소%24 h뇨단백정량
severe preeclampsia%hypothyroidism%thyriod hormone%24-hour urine protein
目的：探讨先兆子痫中24 h尿蛋白定量对甲状腺激素水平的影响，阐明重度尿蛋白对先兆子痫伴发甲状腺功能减退的影响。方法选择先兆子痫患者166例，按其24 h尿蛋白定量检测结果分为尿蛋白轻度组（2.0~4.9 g/d，简称为轻度组）、尿蛋白中度组（5~10 g/d，简称为中度组）和尿蛋白重度组（>10 g/d，简称为重度组）。随机抽取同期孕周、年龄匹配的血压正常、尿常规蛋白阴性、无产科合并症的健康孕妇268例为正常对照组。采用化学发光微粒免疫分析技术测定促甲状腺激素（TSH）、血清游离三碘甲腺原氨酸（FT3）和血清游离甲状腺素（FT4）水平，采用化学发光法测定甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb），采用免疫比浊法检测24 h尿蛋白定量。结果轻度组、中度组、重度组3组与正常对照组比较，重度组与轻度组比较，TSH水平均明显升高（P<0.01），FT4及FT3水平均明显降低（P<0.01或0.05）。重度组与中度组比较，FT4水平明显降低（P<0.05）。轻度组与中度组比较，TPOAb阳性率明显升高（OR=9.8，P<0.05），TGAb阳性率无明显变化（P>0.05）。重度组与轻度组、正常对照组比较，亚临床甲减发生率和临床甲减发生率均显著升高（分别为OR=2.5，P<0.05；OR=9.0，P<0.05和OR=8.0，P<0.01；OR=43.4，P<0.01）。结论先兆子痫患者中24 h尿蛋白定量影响甲状腺激素水平，TSH水平随尿蛋白定量增加而升高，FT4随尿蛋白定量的增加而降低。TPOAb阳性对24 h尿蛋白定量有影响。先兆子痫患者甲状腺功能减退发生率随24 h尿蛋白定量的增加而增加。尿蛋白是先兆子痫患者发生甲状腺功能减退的危险因素，应重视先兆子痫患者24 h尿蛋白定量的反复监测。
目的：探討先兆子癇中24 h尿蛋白定量對甲狀腺激素水平的影響，闡明重度尿蛋白對先兆子癇伴髮甲狀腺功能減退的影響。方法選擇先兆子癇患者166例，按其24 h尿蛋白定量檢測結果分為尿蛋白輕度組（2.0~4.9 g/d，簡稱為輕度組）、尿蛋白中度組（5~10 g/d，簡稱為中度組）和尿蛋白重度組（>10 g/d，簡稱為重度組）。隨機抽取同期孕週、年齡匹配的血壓正常、尿常規蛋白陰性、無產科閤併癥的健康孕婦268例為正常對照組。採用化學髮光微粒免疫分析技術測定促甲狀腺激素（TSH）、血清遊離三碘甲腺原氨痠（FT3）和血清遊離甲狀腺素（FT4）水平，採用化學髮光法測定甲狀腺過氧化物酶抗體（TPOAb）、甲狀腺毬蛋白抗體（TGAb），採用免疫比濁法檢測24 h尿蛋白定量。結果輕度組、中度組、重度組3組與正常對照組比較，重度組與輕度組比較，TSH水平均明顯升高（P<0.01），FT4及FT3水平均明顯降低（P<0.01或0.05）。重度組與中度組比較，FT4水平明顯降低（P<0.05）。輕度組與中度組比較，TPOAb暘性率明顯升高（OR=9.8，P<0.05），TGAb暘性率無明顯變化（P>0.05）。重度組與輕度組、正常對照組比較，亞臨床甲減髮生率和臨床甲減髮生率均顯著升高（分彆為OR=2.5，P<0.05；OR=9.0，P<0.05和OR=8.0，P<0.01；OR=43.4，P<0.01）。結論先兆子癇患者中24 h尿蛋白定量影響甲狀腺激素水平，TSH水平隨尿蛋白定量增加而升高，FT4隨尿蛋白定量的增加而降低。TPOAb暘性對24 h尿蛋白定量有影響。先兆子癇患者甲狀腺功能減退髮生率隨24 h尿蛋白定量的增加而增加。尿蛋白是先兆子癇患者髮生甲狀腺功能減退的危險因素，應重視先兆子癇患者24 h尿蛋白定量的反複鑑測。
목적：탐토선조자간중24 h뇨단백정량대갑상선격소수평적영향，천명중도뇨단백대선조자간반발갑상선공능감퇴적영향。방법선택선조자간환자166례，안기24 h뇨단백정량검측결과분위뇨단백경도조（2.0~4.9 g/d，간칭위경도조）、뇨단백중도조（5~10 g/d，간칭위중도조）화뇨단백중도조（>10 g/d，간칭위중도조）。수궤추취동기잉주、년령필배적혈압정상、뇨상규단백음성、무산과합병증적건강잉부268례위정상대조조。채용화학발광미립면역분석기술측정촉갑상선격소（TSH）、혈청유리삼전갑선원안산（FT3）화혈청유리갑상선소（FT4）수평，채용화학발광법측정갑상선과양화물매항체（TPOAb）、갑상선구단백항체（TGAb），채용면역비탁법검측24 h뇨단백정량。결과경도조、중도조、중도조3조여정상대조조비교，중도조여경도조비교，TSH수평균명현승고（P<0.01），FT4급FT3수평균명현강저（P<0.01혹0.05）。중도조여중도조비교，FT4수평명현강저（P<0.05）。경도조여중도조비교，TPOAb양성솔명현승고（OR=9.8，P<0.05），TGAb양성솔무명현변화（P>0.05）。중도조여경도조、정상대조조비교，아림상갑감발생솔화림상갑감발생솔균현저승고（분별위OR=2.5，P<0.05；OR=9.0，P<0.05화OR=8.0，P<0.01；OR=43.4，P<0.01）。결론선조자간환자중24 h뇨단백정량영향갑상선격소수평，TSH수평수뇨단백정량증가이승고，FT4수뇨단백정량적증가이강저。TPOAb양성대24 h뇨단백정량유영향。선조자간환자갑상선공능감퇴발생솔수24 h뇨단백정량적증가이증가。뇨단백시선조자간환자발생갑상선공능감퇴적위험인소，응중시선조자간환자24 h뇨단백정량적반복감측。
Objective To study the effects of quantitative 24-hour urinary protein on the thyroid hormone levels in patients with severe preeclamp-sia,and clarify the impact of severe urinary protein on hypothyroid in severe preeclampsia patients. Methods A total of 166 patients with severe pre-eclampsia were recruited for the study and divided into mild proteinuria group(2.0-4.9 g/d),midrange group(5-10 g/d)and severe group(>10 g/d)according to the quantitative 24-hour urinary protein. 268 healthy female individuals with normal blood pressure and uric routine in the same stage of pregnancy and of the same age were selected into control group. Serum thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine (FT4)levels were determined by solid-phase chemiluminescent enzyme immunoassay method(CMIA). The thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TGAb)concentration were detected by electrochemiluminescent assay(ECLIA). Results TSH levels were signifi-cantly higher in patients comparing to the control group(P<0.01). In addition,severe group showed higher TSH levels than mild group(P<0.01). FT4 and FT3 levels were obviously decreased with the progression of the disease(P<0.01 and P<0.05). The positive rate of TPOAb in mild group was significantly higher than that in moderate group(OR=9.8,P<0.05). There was no significant difference of the TGAb positive rate among three patient groups(P>0.05). The incidence of subclinical hypothyroidism and clinical hypothyroidism in severe group was significantly higher than that in mild group and in control group(OR=2.5,P<0.05 and OR=9.0,P<0.05;OR=8.0,P<0.01 and OR=43.4,P<0.01). Conclusion Our re-sults indicated that 24-hour urine protein in severe preeclampsia patients has extensive effects on thyroid hormones levels. With the increasing of quantitative 24-hour urinary protein,the level of TSH increased and the FT4 decreased. Thyroid autoantibody positiveness has extensive effects on 24- hour urine protein. Incidence of hypothyroid increased with the increase of quantitative 24-hour urinary protein. 24-hour urinary protein quantitative was a risk factor for hypothyroidism in severe preeclampsia patients. More attention should be paid to the monitoring of 24-hour urinary protein in se-vere preeclampsia patients.
