目的 探讨重度子痫前期孕妇甲状腺激素水平变化、甲状腺疾病特点及其与重度子痫前期发病的关系.方法 选择2011年5月至2012年12月在中国医科大学附属盛京医院住院并分娩的重度子痫前期孕妇171例为重度子痫前期组,按发病孕周分为早发型114例和晚发型57例.随机抽取同期孕周和年龄与重度子痫前期组相匹配的血压正常、无产科合并症的健康孕妇171例为对照组.采用化学发光微粒免疫分析技术检测各组孕妇血清中促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平,采用化学发光法检测抗甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)水平,并计算其阳性率(TPOAb＞ 5.6 U/L为阳性,TGAb ＞4.1 U/L为阳性).对重度子痫前期组孕妇血清TSH、FT3及FT4水平与血压的相关性进行分析.结果 (1)重度子痫前期组孕妇TSH中位水平为3.4 mU/L,FT4、FT3水平分别为(12.0±3.0)、(3.9 ±0.9) pmol/L;对照组分别为1.9 mU/L、(13.4±2.4)和(5.0±1.3) pmol/L,两组分别比较,差异均有统计学意义(P＜0.01).其中早发型孕妇TSH中位水平为3.3 mU/L,FT4、FT3水平分别为(12.1±3.4)、(3.8±0.9)pmol/L;晚发型孕妇TSH中位水平为3.4 mU/L,FT4、FT3水平分别为(11.9±3.1)、(3.9±1.0)pmol/L,分别与对照组比较,差异有统计学意义(P＜0.01)；早发型与晚发型孕妇各指标分别比较,差异均无统计学意义(P＞0.05).(2)重度子痫前期组孕妇TPOAb和TGAb阳性率分别为15.2％(26/171)和21.6％ (37/171)；对照组孕妇分别为12.3％ (21/171)和14.6％ (25/171),两组孕妇TGAb阳性率比较,差异有统计学意义(P＜0.01)；TPOAb阳性率比较,差异无统计学意义(P＞0.05).其中早发型孕妇TPOAb阳性率为12.3％ (14/114),晚发型孕妇为21.1％ (12/57),两者比较,差异无统计学意义(P＞0.05)；早发型孕妇TGAb阳性率为21.9％(25/114),晚发型孕妇为21.1％(12/57),两者比较,差异无统计学意义(P＞0.05).晚发型与对照组TPOAb阳性率比较,差异有统计学意义(P＜0.01).(3)重度子痫前期组及对照组孕妇甲状腺疾病患病率分别为47.4％(81/171)和16.4％ (28/171),两组比较,差异有统计学意义(P＜0.01).(4)重度子痫前期组及对照组孕妇亚临床甲状腺功能减退症(亚甲减)[或甲状腺功能减退症(甲减)]患病率分别为45.0％(77/171)和16.4％ (28/171),两组比较,差异有统计学意义(P＜0.01).(5)重度子痫前期组及对照组孕妇亚临床甲状腺功能亢进症(亚甲亢)患病率分别为2.3％ (4/171)和1.8％ (3/171),两组比较,差异无统计学意义(P＞0.05).(6)重度子痫前期组TSH水平为0.3～3.3 mU/L的孕妇,收缩压为(170 ±21)mmHg(1 mmHg =0.133 kPa),舒张压为(112±15) mmHg;TSH水平＞3.3 mU/L的孕妇,收缩压为(166±21) mmHg,舒张压为(109±13) mmHg,两者比较,差异无统计学意义(P＞0.05).其中早发型与晚发型孕妇舒张压比较,差异有统计学意义(P＜0.01).重度子痫前期组孕妇血清TSH及FT4水平与收缩压及舒张压均无相关性(P＞0.05),FT3与舒张压存在负相关性(r=-0.172,P=0.023).结论 重度子痫前期孕妇常伴随甲状腺功能的改变,且以亚甲减多见,提示有必要对重度子痫前期孕妇行甲状腺激素水平及其抗体检查；重度子痫前期孕妇血清中FT4和FT3水平降低及TSH水平升高、TPOAb及TGAb阳性与重度子痫前期发生密切相关.
目的 探討重度子癇前期孕婦甲狀腺激素水平變化、甲狀腺疾病特點及其與重度子癇前期髮病的關繫.方法 選擇2011年5月至2012年12月在中國醫科大學附屬盛京醫院住院併分娩的重度子癇前期孕婦171例為重度子癇前期組,按髮病孕週分為早髮型114例和晚髮型57例.隨機抽取同期孕週和年齡與重度子癇前期組相匹配的血壓正常、無產科閤併癥的健康孕婦171例為對照組.採用化學髮光微粒免疫分析技術檢測各組孕婦血清中促甲狀腺激素(TSH)、遊離三碘甲狀腺原氨痠(FT3)、遊離甲狀腺素(FT4)水平,採用化學髮光法檢測抗甲狀腺過氧化物酶抗體(TPOAb)、甲狀腺毬蛋白抗體(TGAb)水平,併計算其暘性率(TPOAb＞ 5.6 U/L為暘性,TGAb ＞4.1 U/L為暘性).對重度子癇前期組孕婦血清TSH、FT3及FT4水平與血壓的相關性進行分析.結果 (1)重度子癇前期組孕婦TSH中位水平為3.4 mU/L,FT4、FT3水平分彆為(12.0±3.0)、(3.9 ±0.9) pmol/L;對照組分彆為1.9 mU/L、(13.4±2.4)和(5.0±1.3) pmol/L,兩組分彆比較,差異均有統計學意義(P＜0.01).其中早髮型孕婦TSH中位水平為3.3 mU/L,FT4、FT3水平分彆為(12.1±3.4)、(3.8±0.9)pmol/L;晚髮型孕婦TSH中位水平為3.4 mU/L,FT4、FT3水平分彆為(11.9±3.1)、(3.9±1.0)pmol/L,分彆與對照組比較,差異有統計學意義(P＜0.01)；早髮型與晚髮型孕婦各指標分彆比較,差異均無統計學意義(P＞0.05).(2)重度子癇前期組孕婦TPOAb和TGAb暘性率分彆為15.2％(26/171)和21.6％ (37/171)；對照組孕婦分彆為12.3％ (21/171)和14.6％ (25/171),兩組孕婦TGAb暘性率比較,差異有統計學意義(P＜0.01)；TPOAb暘性率比較,差異無統計學意義(P＞0.05).其中早髮型孕婦TPOAb暘性率為12.3％ (14/114),晚髮型孕婦為21.1％ (12/57),兩者比較,差異無統計學意義(P＞0.05)；早髮型孕婦TGAb暘性率為21.9％(25/114),晚髮型孕婦為21.1％(12/57),兩者比較,差異無統計學意義(P＞0.05).晚髮型與對照組TPOAb暘性率比較,差異有統計學意義(P＜0.01).(3)重度子癇前期組及對照組孕婦甲狀腺疾病患病率分彆為47.4％(81/171)和16.4％ (28/171),兩組比較,差異有統計學意義(P＜0.01).(4)重度子癇前期組及對照組孕婦亞臨床甲狀腺功能減退癥(亞甲減)[或甲狀腺功能減退癥(甲減)]患病率分彆為45.0％(77/171)和16.4％ (28/171),兩組比較,差異有統計學意義(P＜0.01).(5)重度子癇前期組及對照組孕婦亞臨床甲狀腺功能亢進癥(亞甲亢)患病率分彆為2.3％ (4/171)和1.8％ (3/171),兩組比較,差異無統計學意義(P＞0.05).(6)重度子癇前期組TSH水平為0.3～3.3 mU/L的孕婦,收縮壓為(170 ±21)mmHg(1 mmHg =0.133 kPa),舒張壓為(112±15) mmHg;TSH水平＞3.3 mU/L的孕婦,收縮壓為(166±21) mmHg,舒張壓為(109±13) mmHg,兩者比較,差異無統計學意義(P＞0.05).其中早髮型與晚髮型孕婦舒張壓比較,差異有統計學意義(P＜0.01).重度子癇前期組孕婦血清TSH及FT4水平與收縮壓及舒張壓均無相關性(P＞0.05),FT3與舒張壓存在負相關性(r=-0.172,P=0.023).結論 重度子癇前期孕婦常伴隨甲狀腺功能的改變,且以亞甲減多見,提示有必要對重度子癇前期孕婦行甲狀腺激素水平及其抗體檢查；重度子癇前期孕婦血清中FT4和FT3水平降低及TSH水平升高、TPOAb及TGAb暘性與重度子癇前期髮生密切相關.
목적 탐토중도자간전기잉부갑상선격소수평변화、갑상선질병특점급기여중도자간전기발병적관계.방법 선택2011년5월지2012년12월재중국의과대학부속성경의원주원병분면적중도자간전기잉부171례위중도자간전기조,안발병잉주분위조발형114례화만발형57례.수궤추취동기잉주화년령여중도자간전기조상필배적혈압정상、무산과합병증적건강잉부171례위대조조.채용화학발광미립면역분석기술검측각조잉부혈청중촉갑상선격소(TSH)、유리삼전갑상선원안산(FT3)、유리갑상선소(FT4)수평,채용화학발광법검측항갑상선과양화물매항체(TPOAb)、갑상선구단백항체(TGAb)수평,병계산기양성솔(TPOAb＞ 5.6 U/L위양성,TGAb ＞4.1 U/L위양성).대중도자간전기조잉부혈청TSH、FT3급FT4수평여혈압적상관성진행분석.결과 (1)중도자간전기조잉부TSH중위수평위3.4 mU/L,FT4、FT3수평분별위(12.0±3.0)、(3.9 ±0.9) pmol/L;대조조분별위1.9 mU/L、(13.4±2.4)화(5.0±1.3) pmol/L,량조분별비교,차이균유통계학의의(P＜0.01).기중조발형잉부TSH중위수평위3.3 mU/L,FT4、FT3수평분별위(12.1±3.4)、(3.8±0.9)pmol/L;만발형잉부TSH중위수평위3.4 mU/L,FT4、FT3수평분별위(11.9±3.1)、(3.9±1.0)pmol/L,분별여대조조비교,차이유통계학의의(P＜0.01)；조발형여만발형잉부각지표분별비교,차이균무통계학의의(P＞0.05).(2)중도자간전기조잉부TPOAb화TGAb양성솔분별위15.2％(26/171)화21.6％ (37/171)；대조조잉부분별위12.3％ (21/171)화14.6％ (25/171),량조잉부TGAb양성솔비교,차이유통계학의의(P＜0.01)；TPOAb양성솔비교,차이무통계학의의(P＞0.05).기중조발형잉부TPOAb양성솔위12.3％ (14/114),만발형잉부위21.1％ (12/57),량자비교,차이무통계학의의(P＞0.05)；조발형잉부TGAb양성솔위21.9％(25/114),만발형잉부위21.1％(12/57),량자비교,차이무통계학의의(P＞0.05).만발형여대조조TPOAb양성솔비교,차이유통계학의의(P＜0.01).(3)중도자간전기조급대조조잉부갑상선질병환병솔분별위47.4％(81/171)화16.4％ (28/171),량조비교,차이유통계학의의(P＜0.01).(4)중도자간전기조급대조조잉부아림상갑상선공능감퇴증(아갑감)[혹갑상선공능감퇴증(갑감)]환병솔분별위45.0％(77/171)화16.4％ (28/171),량조비교,차이유통계학의의(P＜0.01).(5)중도자간전기조급대조조잉부아림상갑상선공능항진증(아갑항)환병솔분별위2.3％ (4/171)화1.8％ (3/171),량조비교,차이무통계학의의(P＞0.05).(6)중도자간전기조TSH수평위0.3～3.3 mU/L적잉부,수축압위(170 ±21)mmHg(1 mmHg =0.133 kPa),서장압위(112±15) mmHg;TSH수평＞3.3 mU/L적잉부,수축압위(166±21) mmHg,서장압위(109±13) mmHg,량자비교,차이무통계학의의(P＞0.05).기중조발형여만발형잉부서장압비교,차이유통계학의의(P＜0.01).중도자간전기조잉부혈청TSH급FT4수평여수축압급서장압균무상관성(P＞0.05),FT3여서장압존재부상관성(r=-0.172,P=0.023).결론 중도자간전기잉부상반수갑상선공능적개변,차이아갑감다견,제시유필요대중도자간전기잉부행갑상선격소수평급기항체검사；중도자간전기잉부혈청중FT4화FT3수평강저급TSH수평승고、TPOAb급TGAb양성여중도자간전기발생밀절상관.
Objective To study thyroid hormone changes in women with pre-eclampsia patients,the characteristics of thyroid disease and its relationship with pre-eclampsia.Methods From May 2011 to December 2012 171 patients with pre-eclampsia who delivered in Shengjing Hospital of China Medical University were recruited as prc-eclampsia(PE) group,among which 114 cases were defined as early onset pre-eclampsia (EP) group and 57 cases were defined as late onset pre-eclampsia (LP) group.And 171 healthy women with same age and same stage of pregnancy were selected as the control group.Their blood pressures were normal and they had no obstetrical complications.Serum thyrotropin (TSH),free triiodothyronine (FT3) and free thyroxine (FT4) levels were determined by solid-phase chemiluminescent enzyme immunoassay method (CMIA).Thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were measured by electro-chemiluminescent assay (ECLIA).The positive rate was calculated (TPOAb ＞ 5.6 U/L,TGAb ＞ 4.1 U/L were defined as positive result).The relationship between TSH,FT3,FT4 level and blood pressure was analyzed in women with pre-eclampsia.Results (1) The median values of TSH,FT4 and FT3 in PE group were 3.4 mU/L,(12.0 ± 3.0) pmol/L and(3.9 ± 0.9) pmol/L.In the control group,they were 1.9 mU/L,(13.4 ± 2.4) and (5.0 ± 1.3) pmol/L.There were statistically significant differences between the two groups(P ＜ 0.01).In EP group,the median values of TSH,FT4 and FT3 were 3.3 mU/L,(12.1 ± 3.4) pmol/L and (3.8 ± 0.9) pmol/L.The differences between EP group and the control group were statistically significant (P ＜ 0.01).In LP group,the median values of TSH,FT4 and FT3 were 3.4 mU/L,(11.9 ± 3.1) pmol/L and (3.9 ± 1.0) pmol/L.There were statistically significant differences compared to the control group(P ＜0.01).While there was no difference between EP group and LP group (P ＞ 0.05).(2) The positive rate of TPOAb and TGAb in PE group were 15.2％ (26/171)and 21.6％ (37/171),and were 12.3％ (21/171) and 14.6％ (25/171) in the control group.There was statistically significant difference in the TGAb positive rate (P ＜ 0.01),but the difference in TPOAb positive rate was not statistically different(P ＞0.05).The TPOAb positive rates in EP group and LP group were 12.3 ％ (14/114) and 21.1％ (12/57),respectively,with no statistically significant difference (P ＞ 0.05).And the positive rates of TGAb in EP group and LP group were 21.9％ (25/114)and 21.1％ (12/57),respectively,with no statistically significant difference(P ＞ 0.05).The positive rate of TPOAb in LP group and in the control group had statistically significant difference(P ＜0.01).(3) The morbidity of thyroid disease in PE group and in the control group were 47.4％ (81/171) and 16.4％ (28/171),with statistically significant difference (P ＜ 0.01).(4) The morbidity of subclinical hypothyroidism or hypothyroidism in PE group and in the control group were 45.0％ (77/171) and 16.4％ (28/171),with statistically significant difference(P ＜0.01).(5) The morbidity of subclinical hyperthyroidism in PE group and in the control group were 2.3 ％ (4/171) and 1.8 ％ (3/171),with no statistically significant difference (P＞0.05).(6) In PE group,women with TSH level of 0.3-3.3 mU/L had systolic pressure of(170 ± 21)mmHg (1mmHg =0.133 kPa)and diastolic pressure of(112 ± 15) mmHg; women with TSH ＞ 3.3 mU/L had systolic pressure of(166 ± 21)mmHg and diastolic pressure of(109 ± 13)mmHg.There was no statistically significant difference(P ＞ 0.05).But the diastolic pressure in EP group and LP group had statistically significant difference(P ＜ 0.01).In PE group,no correlation was found among TSH,FT4 levels and systolic pressure,diastolic pressure(P ＞ 0.05).FT3 level was negatively correlated to diastolic pressure (r =-0.172,P =0.023).Conclusions It is common that pre-eclampsia is complicated with thyroid dysfunction,mainly subclinical hypothyroidism.Thus it is nessesary to test thyroid hormone and thyroid antibodies in women with pre-eclampsia.The decrease of FT3 and FT4,the increase of TSH and the presence of TPOAb and TGAb are related with the presence of pre-eclampsia.
