目的：探讨孕早期合并亚临床甲状腺功能减退（亚甲减）及其甲状腺过氧化物酶抗体（TPOAb）阳性孕妇治疗与否对围产结局的影响。方法2013年1月1日至2014年6月30日郑州市妇幼保健院分娩孕妇15000例，其中孕早期合并亚甲减孕妇2042例，其诊断标准为促甲状腺素（TSH）水平5.22~10.00 mU/L、血清游离甲状腺素（FT4）水平12.91~22.35 pmol/L；TPOAb水平≥34 U/L为阳性。2042例亚甲减孕妇根据是否接受左旋甲状腺素片治疗分为亚甲减治疗组（1236例）和亚甲减未治疗组（806例）；同时根据2042例亚甲减孕妇TPOAb检测结果是否阳性及是否接受左旋甲状腺素片治疗，分为TPOAb（+）治疗组（1021例）、TPOAb（+）未治疗组（201例），TPOAb（-）治疗组（215例）、TPOAb（-）未治疗组（605例）。选取同期甲状腺功能正常孕妇2000例作为对照组。对各组孕妇围产结局进行分析。结果（1）孕早期合并亚甲减的发生率为13.61%（2042/15000）；治疗率为60.53%（1236/2042），未治疗率为39.47%（806/2042）。（2）亚甲减未治疗组孕妇流产（5.71%，46/806）、早产（6.20%，50/806）、妊娠期高血压疾病（13.90%，112/806）、妊娠期糖尿病[GDM；6.58%（53/806）]、胎儿生长受限[FGR；12.28%（99/806）]及出生低体质量儿（10.17%，82/806）的发生率均高于亚甲减治疗组分别为3.96%（49/1236）、4.21%（52/1236）、10.76%（133/1236）、4.13%（51/1236）、8.90%（110/1236）、7.52%（93/1236）及对照组[分别为3.60%（72/2000）、4.00%（80/2000）、10.70%（214/2000）、3.80%（76/2000）、9.60%（192/2000）、7.50%（150/2000）]，分别比较，差异均有统计学意义（P<0.05）；胎盘早剥、孕妇贫血、胎儿窘迫的发生率在亚甲减治疗组、亚甲减未治疗组及对照组之间分别比较，差异均无统计学意义（P>0.05）。（3）TPOAb（+）未治疗组孕妇流产（11.44%，23/201）、早产（12.44%，25/201）、妊娠期高血压疾病（22.89%，46/201）、GDM（8.46%，17/201）、FGR（19.90%，40/201）及出生低体质量儿（16.42%，33/201）的发生率均高于TPOAb（+）治疗组[分别为4.02%（41/1021）、4.21%（43/1021）、10.77%（110/1021）、4.11%（42/1021）、8.72%（89/1021）、7.35%（75/1021）]和对照组，分别比较，差异均有统计学意义（P<0.05）；TPOAb（+）治疗组孕妇不良围产结局发生率虽高于对照组，但差异均无统计学意义（P>0.05）。（4）TPOAb（-）治疗组孕妇流产（3.72%，8/215）、早产（4.19%，9/215）、妊娠期高血压疾病（10.70%，23/215）、GDM（4.19%，9/215）、FGR（9.77%，21/215）及出生低体质量儿（8.37%，18/215）的发生率分别与TPOAb（-）未治疗组[分别为3.80%（23/605）、4.13%（25/605）、10.91%（66/605）、5.95%（36/605）、9.75%（59/605）、8.10%（49/605）]及对照组比较，差异均无统计学意义（P>0.05）。结论（1）孕早期合并亚甲减可增加流产、早产、妊娠期高血压疾病、GDM、FGR及出生低体质量儿的发生率；（2）左旋甲状腺素片治疗可有效降低孕早期合并亚甲减孕妇及其中TPOAb（+）孕妇的妊娠并发症及合并症的发生率。
目的：探討孕早期閤併亞臨床甲狀腺功能減退（亞甲減）及其甲狀腺過氧化物酶抗體（TPOAb）暘性孕婦治療與否對圍產結跼的影響。方法2013年1月1日至2014年6月30日鄭州市婦幼保健院分娩孕婦15000例，其中孕早期閤併亞甲減孕婦2042例，其診斷標準為促甲狀腺素（TSH）水平5.22~10.00 mU/L、血清遊離甲狀腺素（FT4）水平12.91~22.35 pmol/L；TPOAb水平≥34 U/L為暘性。2042例亞甲減孕婦根據是否接受左鏇甲狀腺素片治療分為亞甲減治療組（1236例）和亞甲減未治療組（806例）；同時根據2042例亞甲減孕婦TPOAb檢測結果是否暘性及是否接受左鏇甲狀腺素片治療，分為TPOAb（+）治療組（1021例）、TPOAb（+）未治療組（201例），TPOAb（-）治療組（215例）、TPOAb（-）未治療組（605例）。選取同期甲狀腺功能正常孕婦2000例作為對照組。對各組孕婦圍產結跼進行分析。結果（1）孕早期閤併亞甲減的髮生率為13.61%（2042/15000）；治療率為60.53%（1236/2042），未治療率為39.47%（806/2042）。（2）亞甲減未治療組孕婦流產（5.71%，46/806）、早產（6.20%，50/806）、妊娠期高血壓疾病（13.90%，112/806）、妊娠期糖尿病[GDM；6.58%（53/806）]、胎兒生長受限[FGR；12.28%（99/806）]及齣生低體質量兒（10.17%，82/806）的髮生率均高于亞甲減治療組分彆為3.96%（49/1236）、4.21%（52/1236）、10.76%（133/1236）、4.13%（51/1236）、8.90%（110/1236）、7.52%（93/1236）及對照組[分彆為3.60%（72/2000）、4.00%（80/2000）、10.70%（214/2000）、3.80%（76/2000）、9.60%（192/2000）、7.50%（150/2000）]，分彆比較，差異均有統計學意義（P<0.05）；胎盤早剝、孕婦貧血、胎兒窘迫的髮生率在亞甲減治療組、亞甲減未治療組及對照組之間分彆比較，差異均無統計學意義（P>0.05）。（3）TPOAb（+）未治療組孕婦流產（11.44%，23/201）、早產（12.44%，25/201）、妊娠期高血壓疾病（22.89%，46/201）、GDM（8.46%，17/201）、FGR（19.90%，40/201）及齣生低體質量兒（16.42%，33/201）的髮生率均高于TPOAb（+）治療組[分彆為4.02%（41/1021）、4.21%（43/1021）、10.77%（110/1021）、4.11%（42/1021）、8.72%（89/1021）、7.35%（75/1021）]和對照組，分彆比較，差異均有統計學意義（P<0.05）；TPOAb（+）治療組孕婦不良圍產結跼髮生率雖高于對照組，但差異均無統計學意義（P>0.05）。（4）TPOAb（-）治療組孕婦流產（3.72%，8/215）、早產（4.19%，9/215）、妊娠期高血壓疾病（10.70%，23/215）、GDM（4.19%，9/215）、FGR（9.77%，21/215）及齣生低體質量兒（8.37%，18/215）的髮生率分彆與TPOAb（-）未治療組[分彆為3.80%（23/605）、4.13%（25/605）、10.91%（66/605）、5.95%（36/605）、9.75%（59/605）、8.10%（49/605）]及對照組比較，差異均無統計學意義（P>0.05）。結論（1）孕早期閤併亞甲減可增加流產、早產、妊娠期高血壓疾病、GDM、FGR及齣生低體質量兒的髮生率；（2）左鏇甲狀腺素片治療可有效降低孕早期閤併亞甲減孕婦及其中TPOAb（+）孕婦的妊娠併髮癥及閤併癥的髮生率。
목적：탐토잉조기합병아림상갑상선공능감퇴（아갑감）급기갑상선과양화물매항체（TPOAb）양성잉부치료여부대위산결국적영향。방법2013년1월1일지2014년6월30일정주시부유보건원분면잉부15000례，기중잉조기합병아갑감잉부2042례，기진단표준위촉갑상선소（TSH）수평5.22~10.00 mU/L、혈청유리갑상선소（FT4）수평12.91~22.35 pmol/L；TPOAb수평≥34 U/L위양성。2042례아갑감잉부근거시부접수좌선갑상선소편치료분위아갑감치료조（1236례）화아갑감미치료조（806례）；동시근거2042례아갑감잉부TPOAb검측결과시부양성급시부접수좌선갑상선소편치료，분위TPOAb（+）치료조（1021례）、TPOAb（+）미치료조（201례），TPOAb（-）치료조（215례）、TPOAb（-）미치료조（605례）。선취동기갑상선공능정상잉부2000례작위대조조。대각조잉부위산결국진행분석。결과（1）잉조기합병아갑감적발생솔위13.61%（2042/15000）；치료솔위60.53%（1236/2042），미치료솔위39.47%（806/2042）。（2）아갑감미치료조잉부유산（5.71%，46/806）、조산（6.20%，50/806）、임신기고혈압질병（13.90%，112/806）、임신기당뇨병[GDM；6.58%（53/806）]、태인생장수한[FGR；12.28%（99/806）]급출생저체질량인（10.17%，82/806）적발생솔균고우아갑감치료조분별위3.96%（49/1236）、4.21%（52/1236）、10.76%（133/1236）、4.13%（51/1236）、8.90%（110/1236）、7.52%（93/1236）급대조조[분별위3.60%（72/2000）、4.00%（80/2000）、10.70%（214/2000）、3.80%（76/2000）、9.60%（192/2000）、7.50%（150/2000）]，분별비교，차이균유통계학의의（P<0.05）；태반조박、잉부빈혈、태인군박적발생솔재아갑감치료조、아갑감미치료조급대조조지간분별비교，차이균무통계학의의（P>0.05）。（3）TPOAb（+）미치료조잉부유산（11.44%，23/201）、조산（12.44%，25/201）、임신기고혈압질병（22.89%，46/201）、GDM（8.46%，17/201）、FGR（19.90%，40/201）급출생저체질량인（16.42%，33/201）적발생솔균고우TPOAb（+）치료조[분별위4.02%（41/1021）、4.21%（43/1021）、10.77%（110/1021）、4.11%（42/1021）、8.72%（89/1021）、7.35%（75/1021）]화대조조，분별비교，차이균유통계학의의（P<0.05）；TPOAb（+）치료조잉부불량위산결국발생솔수고우대조조，단차이균무통계학의의（P>0.05）。（4）TPOAb（-）치료조잉부유산（3.72%，8/215）、조산（4.19%，9/215）、임신기고혈압질병（10.70%，23/215）、GDM（4.19%，9/215）、FGR（9.77%，21/215）급출생저체질량인（8.37%，18/215）적발생솔분별여TPOAb（-）미치료조[분별위3.80%（23/605）、4.13%（25/605）、10.91%（66/605）、5.95%（36/605）、9.75%（59/605）、8.10%（49/605）]급대조조비교，차이균무통계학의의（P>0.05）。결론（1）잉조기합병아갑감가증가유산、조산、임신기고혈압질병、GDM、FGR급출생저체질량인적발생솔；（2）좌선갑상선소편치료가유효강저잉조기합병아갑감잉부급기중TPOAb（+）잉부적임신병발증급합병증적발생솔。
Objective To investigate if women with subclinical hypothyroidism (SCH), positive thyroid gland peroxidase antibody(TPOAb) in early pregnancy accepted treatment or not had effect on perinatal outcomes. Methods 15 000 pregnant women who delivered in Women and Infants Hospital of Zhengzhou from January 1, 2013 to June 30, 2014 were recruited retrospectively. Among them, 2 042 women had SCH in early pregnancy. The diagnostic standard of SCH was serum free thyroxine (FT4) between 12.91-22.35 pmol/L and TSH level between 5.22-10.00 mU/L. TPOAb level ≥34 U/L was defined as positive result. The 2 042 patients with SCH were divided into the treated group (1 236 cases) and the untreated group (806 cases), according to whether or not women accepted the levothyroxine treatment. Meanwhile, the 2 042 patients with SCH were divided into the TPOAb (+) treated group (1 021 cases), the TPOAb (+) untreated group (201 cases), the TPOAb (-) treated group (215 cases) and the TPOAb (-) untreated group (605 cases), according to the TPOAb result and acceptance the levothyroxine treatment. 2 000 pregnant women with normal thyroid function who delivered in the same period were selected as the control group. Perinatal outcomes were analyzed. Results (1) The incidence of SCH in early pregnancy was 13.61%(2 042/15 000). 60.53%(1 236/2 042) accepted levothyroxine treatment and 39.47%(806/2 042) did not. (2) The incidence of abortion (5.71%, 46/806), premature delivery (6.20%, 50/806), gestational hypertension disease (13.90%, 112/806), gestational diabetes mellitus (GDM;6.58%, 53/806), fetal growth restriction (FGR;12.28%, 99/806)and low birth weight infants (10.17%, 82/806)in the untreated group were higher than those in the treated group [3.96%(49/1 236), 4.21%(52/1 236), 10.76%(133/1 236), 4.13%(51/ 1 236), 8.90%(110/1 236), 7.52%(93/1 236), respectively] and the control group [3.60% (72/2 000), 4.00%(80/2 000) , 10.70%(214/2 000) , 3.80%(76/2 000), 9.60%(192/2 000), 7.50%(150/2 000), respectively]. The differences were statistically significant (P<0.05). While there was no statistically significant difference in the incidence of placental abruption, anemia in pregnant women, or fetal distress among the three groups (P>0.05). (3)The incidences of abortion (11.44%, 23/201), premature delivery (12.44%, 25/201), gestational hypertension disease (22.89%, 46/201), GDM (8.46%, 17/201), FGR (19.90%, 40/201) and low birth weight infants (16.42%, 33/201) in the TPOAb (+) untreated group were higher than those in TPOAb (+) treated group [4.02% (41/1 021), 4.21% (43/1 021), 10.77% (110/1 021), 4.11% (42/1 021), 8.72% (89/1 021), 7.35%(75/1 021), respectively] and the control group, with statistically significant differences (P<0.05). The incidence of the pregnancy complications in the TPOAb (+) treated group was higher than those in the control group, but the differences were not statistically significant (P>0.05). (4)There were no statistically significant difference (P> 0.05) in the incidence of abortion (3.72%, 8/215), premature delivery (4.19%, 9/215), gestational hypertension disease (10.70%, 23/215), GDM (4.19%, 9/215), FGR (9.77%, 21/215) or low birth weight infants (8.37%, 18/215) among the TPOAb (-) treated group, the TPOAb (-) untreated group [3.80% (23/605), 4.13%(25/605), 10.91%(66/605), 5.95%(36/605), 9.75%(59/605), 8.10%(49/605), respectively] and the control group. Conclusions (1) The incidence of abortion, premature delivery, gestational hypertension disease, GDM, FGR and low birth weight infants could be increased in women with SCH in early pregnancy.(2) Thyroxine treatment could reduce the incidence of pregnancy complications in women with SCH in early pregnancy. Objective To investigate if women with subclinical hypothyroidism (SCH), positive thyroid gland peroxidase antibody(TPOAb) in early pregnancy accepted treatment or not had effect on perinatal outcomes. Methods 15 000 pregnant women who delivered in Women and Infants Hospital of Zhengzhou from January 1, 2013 to June 30, 2014 were recruited retrospectively. Among them, 2 042 women had SCH in early pregnancy. The diagnostic standard of SCH was serum free thyroxine (FT4) between 12.91-22.35 pmol/L and TSH level between 5.22-10.00 mU/L. TPOAb level ≥34 U/L was defined as positive result. The 2 042 patients with SCH were divided into the treated group (1 236 cases) and the untreated group (806 cases), according to whether or not women accepted the levothyroxine treatment. Meanwhile, the 2 042 patients with SCH were divided into the TPOAb (+) treated group (1 021 cases), the TPOAb (+) untreated group (201 cases), the TPOAb (-) treated group (215 cases) and the TPOAb (-) untreated group (605 cases), according to the TPOAb result and acceptance the levothyroxine treatment. 2 000 pregnant women with normal thyroid function who delivered in the same period were selected as the control group. Perinatal outcomes were analyzed. Results (1) The incidence of SCH in early pregnancy was 13.61%(2 042/15 000). 60.53%(1 236/2 042) accepted levothyroxine treatment and 39.47%(806/2 042) did not. (2) The incidence of abortion (5.71%, 46/806), premature delivery (6.20%, 50/806), gestational hypertension disease (13.90%, 112/806), gestational diabetes mellitus (GDM;6.58%, 53/806), fetal growth restriction (FGR;12.28%, 99/806)and low birth weight infants (10.17%, 82/806)in the untreated group were higher than those in the treated group [3.96%(49/1 236), 4.21%(52/1 236), 10.76%(133/1 236), 4.13%(51/ 1 236), 8.90%(110/1 236), 7.52%(93/1 236), respectively] and the control group [3.60% (72/2 000), 4.00%(80/2 000) , 10.70%(214/2 000) , 3.80%(76/2 000), 9.60%(192/2 000), 7.50%(150/2 000), respectively]. The differences were statistically significant (P<0.05). While there was no statistically significant difference in the incidence of placental abruption, anemia in pregnant women, or fetal distress among the three groups (P>0.05). (3)The incidences of abortion (11.44%, 23/201), premature delivery (12.44%, 25/201), gestational hypertension disease (22.89%, 46/201), GDM (8.46%, 17/201), FGR (19.90%, 40/201) and low birth weight infants (16.42%, 33/201) in the TPOAb (+) untreated group were higher than those in TPOAb (+) treated group [4.02% (41/1 021), 4.21% (43/1 021), 10.77% (110/1 021), 4.11% (42/1 021), 8.72% (89/1 021), 7.35%(75/1 021), respectively] and the control group, with statistically significant differences (P<0.05). The incidence of the pregnancy complications in the TPOAb (+) treated group was higher than those in the control group, but the differences were not statistically significant (P>0.05). (4)There were no statistically significant difference (P> 0.05) in the incidence of abortion (3.72%, 8/215), premature delivery (4.19%, 9/215), gestational hypertension disease (10.70%, 23/215), GDM (4.19%, 9/215), FGR (9.77%, 21/215) or low birth weight infants (8.37%, 18/215) among the TPOAb (-) treated group, the TPOAb (-) untreated group [3.80% (23/605), 4.13%(25/605), 10.91%(66/605), 5.95%(36/605), 9.75%(59/605), 8.10%(49/605), respectively] and the control group. Conclusions (1) The incidence of abortion, premature delivery, gestational hypertension disease, GDM, FGR and low birth weight infants could be increased in women with SCH in early pregnancy.(2) Thyroxine treatment could reduce the incidence of pregnancy complications in women with SCH in early pregnancy.
