CAJ | 학술논문

目的研究宁波地区妊娠妇女在妊娠期间甲状腺激素水平的变化趋势及在妊娠过程中甲状腺功能减退症(甲减)的发生情况.方法选取妇产科门诊开展妊娠期甲状腺疾病流行病学调查的1281例妊娠妇女作为妊娠组,同期体检的163例健康非妊娠妇女作为对照组,采集所有受检者空腹血标本(妊娠组自孕4周起每隔4周1次,至临产时),应用化学发光法测定血清游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPO-Ab).结果妊娠组血清 FT4在孕4、8周与对照组的差异无统计学意义(P >0.05),从孕12周开始下降,孕24周降至最低点,此后一直维持在低水平;TT4从孕4周开始即高于对照组,在孕12周升至高峰,孕24周后一直维持在孕4、8周水平;TT3变化趋势与TT4相似;TSH 在孕4周即低于对照组,至孕12周降至最低,随后逐渐回升,孕36周恢复正常水平,临产时高于对照组;妊娠组检出各种甲减140例,检出率10.93%,TPO-Ab 阳性114例,阳性率8.90%;对照组检出各种甲减7例,检出率4.29%,TPO-Ab 阳性18例,阳性率为11.04%.两组各种甲减检出率的差异有统计学意义(P<0.01),TPO-Ab 阳性检出率的差异无统计学意义(P >0.05).结论妊娠妇女甲状腺激素水平随妊娠月份不断变化,应开展妊娠期甲状腺功能常规筛查.
목적연구저파지구임신부녀재임신기간갑상선격소수평적변화추세급재임신과정중갑상선공능감퇴증(갑감)적발생정황.방법선취부산과문진개전임신기갑상선질병류행병학조사적1281례임신부녀작위임신조,동기체검적163례건강비임신부녀작위대조조,채집소유수검자공복혈표본(임신조자잉4주기매격4주1차,지임산시),응용화학발광법측정혈청유리갑상선소(FT4)、유리삼전갑상선원안산(FT3)、총갑상선소(TT4)、총삼전갑상선원안산(TT3)、촉갑상선격소(TSH)、갑상선과양화물매항체(TPO-Ab).결과임신조혈청 FT4재잉4、8주여대조조적차이무통계학의의(P >0.05),종잉12주개시하강,잉24주강지최저점,차후일직유지재저수평;TT4종잉4주개시즉고우대조조,재잉12주승지고봉,잉24주후일직유지재잉4、8주수평;TT3변화추세여TT4상사;TSH 재잉4주즉저우대조조,지잉12주강지최저,수후축점회승,잉36주회복정상수평,임산시고우대조조;임신조검출각충갑감140례,검출솔10.93%,TPO-Ab 양성114례,양성솔8.90%;대조조검출각충갑감7례,검출솔4.29%,TPO-Ab 양성18례,양성솔위11.04%.량조각충갑감검출솔적차이유통계학의의(P<0.01),TPO-Ab 양성검출솔적차이무통계학의의(P >0.05).결론임신부녀갑상선격소수평수임신월빈불단변화,응개전임신기갑상선공능상규사사.
@@@@Objective To investigate the changes of thyroid hormone levels and occurrence of hypothyroidism during pregnancy. Methods Total 1 281 pregnant women who visited Ningbo University Affiliated Hospital and Ningbo Jiangbei Mater-nal Health Hospital from August 2010 to October 2011, 163 non-pregnant women were included in the study. Serum free thyrox-ine(FT4), free tri odothyronine (FT3), total thyroxine (TT4), total triiodothyronine (TT3), thyrotropin (TSH) and thyroid peroxidase anti-body (TPO-Ab) were measured in al subjects. Results Serum FT4 in pregnant women started to decrease at G12 and reached the minimal level at G24, then remained at low level til the end of the pregnancy. TT4 and TT3 increased to the peak at G12 and G16, then remained at high level. TSH decreased at G4 and went to the lowest level at G12, then increased gradual y and returned to normal levels at G36, it was higher than non-pregnant women at the period of labor. The prevalence of hypothyroidism and positive TPO-Ab among pregnant women were 10.93%(140/1 281) and 8.90%(114/1 281), respectively;those in non-pregnant women were 4.29%(7/163) and 11.04%(18/163), respectively. There was significant difference in the prevalence of hypothyroidism (P<0.01) and no significant difference in prevalence of positive TPO-Ab (P >0.05) between pregnant women and non-pregnant women. Conclusion The levels of serum thyroid hormones fluctuate during the pregnancy. The high prevalence of hypothyroidism during the pregnancy indicates that the screening for thyroid function should be recommended in pregnant women.