中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
11期
738-742
,共5页
佘广彤%王慧艳%陈丽云%贺凤林%方皖仙
佘廣彤%王慧豔%陳麗雲%賀鳳林%方皖仙
사엄동%왕혜염%진려운%하봉림%방환선
甲状腺功能减退症%妊娠结局%妊娠末期
甲狀腺功能減退癥%妊娠結跼%妊娠末期
갑상선공능감퇴증%임신결국%임신말기
Hypothyroidism%Pregnancy outcome%Pregnancy trimester,third
目的 探讨妊娠晚期亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)对妊娠结局及新生儿甲状腺功能的影响. 方法 2012年1月1日至12月31日在南京医科大学附属常州妇幼保健院产前检查的妊娠晚期(妊娠28～42周)孕妇10 695例纳入研究.采用电化学发光技术检测孕妇甲状腺激素水平,随访妊娠结局.时间分辨荧光分析法检测新生儿甲状腺激素水平.采用t检验和x2检验比较SCH和甲状腺功能正常孕妇、SCH孕妇中甲状腺过氧化物酶抗体阳性(40例)和阴性孕妇(176例)的妊娠结局差异. 结果 SCH发生率为2.02％(216/10 695),SCH孕妇中甲状腺过氧化物酶抗体阳性率为18.5％ (40/216).新生儿未检出甲状腺功能异常.甲状腺功能正常孕妇共7 757例,从中按年龄匹配随机抽取222例孕妇作为正常组.与正常组相比,SCH组胎膜早破[28.7％(62/216)与14.9％(33/222),x2=12.34]、妊娠合并贫血[11.6％(25/216)与4.1％(9/222),x2=8.65]、妊娠期高血压疾病[9.7％ (21/216)与4.5％(10/222),x2=4.53]、早产[8.8％(19/216)与3.6％(8/222),x2=5.10]、妊娠期肝内胆汁淤积症的发生率[8.3％[18/216)与2.3％(5/222),x2=8.14]较高(P值均＜0.05).SCH组总体不良妊娠结局发生率也高于正常组[69.4％(150/216)与49.5％(110/222),x2=17.96,P＜0.01].SCH组中甲状腺过氧化物酶抗体阳性者胎儿生长受限和死产的发生率高于阴性者[7.5％(3/40)与0.0％(0、176),x2=13.32,P＜0.01;2.5％(1/40)与0.0％(0、176),x2=4.40,P＜0.05],但总体不良妊娠结局发生率与阴性者比较,差异无统计学意义[65.0％(26/40)与70.5％(124/176),x2=0.46,P=0.50]. 结论 妊娠晚期SCH可增加不良妊娠结局发生风险,建议于妊娠早期进行甲状腺功能筛查.
目的 探討妊娠晚期亞臨床甲狀腺功能減退癥(subclinical hypothyroidism,SCH)對妊娠結跼及新生兒甲狀腺功能的影響. 方法 2012年1月1日至12月31日在南京醫科大學附屬常州婦幼保健院產前檢查的妊娠晚期(妊娠28～42週)孕婦10 695例納入研究.採用電化學髮光技術檢測孕婦甲狀腺激素水平,隨訪妊娠結跼.時間分辨熒光分析法檢測新生兒甲狀腺激素水平.採用t檢驗和x2檢驗比較SCH和甲狀腺功能正常孕婦、SCH孕婦中甲狀腺過氧化物酶抗體暘性(40例)和陰性孕婦(176例)的妊娠結跼差異. 結果 SCH髮生率為2.02％(216/10 695),SCH孕婦中甲狀腺過氧化物酶抗體暘性率為18.5％ (40/216).新生兒未檢齣甲狀腺功能異常.甲狀腺功能正常孕婦共7 757例,從中按年齡匹配隨機抽取222例孕婦作為正常組.與正常組相比,SCH組胎膜早破[28.7％(62/216)與14.9％(33/222),x2=12.34]、妊娠閤併貧血[11.6％(25/216)與4.1％(9/222),x2=8.65]、妊娠期高血壓疾病[9.7％ (21/216)與4.5％(10/222),x2=4.53]、早產[8.8％(19/216)與3.6％(8/222),x2=5.10]、妊娠期肝內膽汁淤積癥的髮生率[8.3％[18/216)與2.3％(5/222),x2=8.14]較高(P值均＜0.05).SCH組總體不良妊娠結跼髮生率也高于正常組[69.4％(150/216)與49.5％(110/222),x2=17.96,P＜0.01].SCH組中甲狀腺過氧化物酶抗體暘性者胎兒生長受限和死產的髮生率高于陰性者[7.5％(3/40)與0.0％(0、176),x2=13.32,P＜0.01;2.5％(1/40)與0.0％(0、176),x2=4.40,P＜0.05],但總體不良妊娠結跼髮生率與陰性者比較,差異無統計學意義[65.0％(26/40)與70.5％(124/176),x2=0.46,P=0.50]. 結論 妊娠晚期SCH可增加不良妊娠結跼髮生風險,建議于妊娠早期進行甲狀腺功能篩查.
목적 탐토임신만기아림상갑상선공능감퇴증(subclinical hypothyroidism,SCH)대임신결국급신생인갑상선공능적영향. 방법 2012년1월1일지12월31일재남경의과대학부속상주부유보건원산전검사적임신만기(임신28～42주)잉부10 695례납입연구.채용전화학발광기술검측잉부갑상선격소수평,수방임신결국.시간분변형광분석법검측신생인갑상선격소수평.채용t검험화x2검험비교SCH화갑상선공능정상잉부、SCH잉부중갑상선과양화물매항체양성(40례)화음성잉부(176례)적임신결국차이. 결과 SCH발생솔위2.02％(216/10 695),SCH잉부중갑상선과양화물매항체양성솔위18.5％ (40/216).신생인미검출갑상선공능이상.갑상선공능정상잉부공7 757례,종중안년령필배수궤추취222례잉부작위정상조.여정상조상비,SCH조태막조파[28.7％(62/216)여14.9％(33/222),x2=12.34]、임신합병빈혈[11.6％(25/216)여4.1％(9/222),x2=8.65]、임신기고혈압질병[9.7％ (21/216)여4.5％(10/222),x2=4.53]、조산[8.8％(19/216)여3.6％(8/222),x2=5.10]、임신기간내담즙어적증적발생솔[8.3％[18/216)여2.3％(5/222),x2=8.14]교고(P치균＜0.05).SCH조총체불량임신결국발생솔야고우정상조[69.4％(150/216)여49.5％(110/222),x2=17.96,P＜0.01].SCH조중갑상선과양화물매항체양성자태인생장수한화사산적발생솔고우음성자[7.5％(3/40)여0.0％(0、176),x2=13.32,P＜0.01;2.5％(1/40)여0.0％(0、176),x2=4.40,P＜0.05],단총체불량임신결국발생솔여음성자비교,차이무통계학의의[65.0％(26/40)여70.5％(124/176),x2=0.46,P=0.50]. 결론 임신만기SCH가증가불량임신결국발생풍험,건의우임신조기진행갑상선공능사사.
Objective To investigate the incidence of subclinical hypothyroidism (SCH) during the third trimester of pregnancy and its effects on pregnancy outcomes and neonatal hypothyroidism.Methods A total of 10 695 women in the third trimester of pregnancy (28-42 weeks of gestation) who labored from January 1,to December 31,2012 in Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University were enrolled.The levels of thyroid stimulating hormone (TSH),free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb) of the mothers were quantified by electrochemical immunoassay.The time-resolved fluorescence immunoassay was used to detect neonatal thyroid hormone levels.Using t test or x2test,the incidence of adverse pregnancy outcomes was compared between SCH group and euthyroid group and between SCH women with positive (n=40) or negative TPOAb (n=176).Results The incidence of SCH was 2.02％ (216/10 695) and the positive rate of TPOAb in SCH women was 18.5％ (40/216).No neonatal thyroid dysfunction was found.According to the age matched,222 cases were randomly selected as controls from 7 757 euthyroid women.Compared with the controls,SCH women had a higher incidence of premature rupture of membranes [28.7％ (62/216) vs 14.9％ (33/222),x2=12.34],anemia [11.6％ (25/216) vs 4.1％ (9/222),x2=8.65],pregnancy-induced hypertension [9.7％ (21/216) vs 4.5％ (10/222),x2=4.53],premature labor [8.8％ (19/216) vs 3.6％ (8/222),x2=5.10] and intrahepatic cholestasis of pregnancy [8.3％(18/216) vs 2.3％ (5/222),x2=8.14] (all P＜0.05).The overall incidence of adverse pregnancy outcomes was also higher in SCH group than in the controls [69.4％ (150/216) vs 49.5％ (110/222),x2=17.96,P＜0.01].The incidence of fetal growth restriction and still birth in SCH mothers with positive TPOAb was higher than in those with negative TPOAb [7.5％ (3/40) vs 0.0％ (0/176),x2=13.32,P＜0.01; 2.5％ (1/40) vs 0.0％ (0/176),x2=4.40,P＜0.05],but there was no significant difference in the overall incidence of adverse pregnancy outcomes compared with TPOAb-negative mothers [65.0％ (26/40) vs 70.5％ (124/176),x2=0.46,P=0.50].Conclusions SCH diagnosed in the third trimester may lead to adverse pregnancy outcomes.Early screening for thyroid dysfunction is necessary.
