妊娠一过性甲状腺毒症的临床研究  

A clinical study on gestational transient thyrotoxicosis

作　　者：温滨红[1] 滕卫平[1] 单忠艳[1] 李元宾[1] 李佳[1] 高波[2] 尚涛[3] 周佳任[3] 李晨阳[4] 周卫卫[5] 丁彬[4] 马英 武英[7] 刘群[8] 刘伟[9] 于晓会[1] 陈彦彦[1] 王薇薇[1] 范晨玲[1] 王红[1] 郭锐[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科内分泌研究所,沈阳110001 [2]沈阳市第四人民医院妇产科 [3]中国医科大学附属盛京医院妇产科 [4]沈阳市第五人民医院妇产科 [5]沈阳市妇婴医院 [6]沈阳市沈洲医院妇产科 [7]沈阳市第九人民医院妇产科 [8]沈阳市和平区妇婴医院 [9]沈阳市第八人民医院妇产科

出　　处：《中华内科杂志》2008年第12期1003-1007,共5页Chinese Journal of Internal Medicine

基　　金：“十五”国家科技攻关计划项目（2004BA720A）;卫生部公益性基金（200802008）;辽宁省重点实验室专项资金计划项目（辽科发[2005]36号-39）;辽宁省科学技术计划项目（2007225010）

摘　　要：目的调查沈阳地区既往健康的妇女妊娠早期妊娠一过性甲状腺毒症（GTT）的患病率及其病因。方法对来自沈阳地区10家医院的534例妊娠早期妇女进行问卷调查、体格检查、血清促甲状腺素（TSH）、游离T4（FT4）、游离T3（FT3）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺素受体抗体（TRAb）和人绒毛膜促性腺激素（hCG）水平的检测。结果（1）妊娠早期甲状腺毒症总患病率为9．75％，GTT的患病率为7．86％，占甲状腺毒症的80．77％；88．89％临床GTT表现为单纯FT3升高。（2）妊娠6、8—10和12周孕妇血清hCG水平逐渐升高，中位数分别为25300、85220和81780IU／L（P=0．000）。血清TSH中位数依次降低（P〈0．01），分别为1．45、1．10和0．84mIU／L。（3）当妊娠妇女血清hCG水平〉50000 IU／L时，GTF的比例明显升高；当血清hCG水平在80000～110000 IU／L时发生亚临床GTT的比例明显升高；当血清hCG水平〉110000IU／L时发生临床GTT的比例明显升高。相关分析结果显示，妊娠早期血清hCG与TSH显著负相关（r=-0．402，P=0．000），与FT3正相关（r=0．165，P=0．000），而与FT4无相关。结论GTT是妊娠早期甲状腺功能亢进症的首要病因，占妊娠早期甲状腺毒症的80．77％，其血清学特点主要表现为血清FT3升高。妊娠早期血清hCG水平与GTF严重程度相关。Objective To investigate the prevalence of gestational transient thyrotoxicosis （GTT） and analyze the cause of thyrotoxicosis encountered in this period. Methods An epidemiologic survey in ten hospitals in Shenyang was performed and 534 pregnant women during the first trimester of pregnancy filled questionaire, received physical examination and had serum thyroid-stimulating hormone （TSH）, free T4 （ FT4 ）, free T3 （ FT3 ）, thyroid peroxidase antibody （ TPOAb）, thyrotrophin receptor antibody（ TRAb）, and human chorionic gonadotrophin （ hCG ） tests. Results （ 1 ） The total prevalence of thyrotoxicosis was 9. 75% （52/534） in the first trimester and the prevalence of GTT was 7. 86%, which accounted for 80. 77% of the thyroxicosis encountered in this period. A total of 88.89% of the overt GTT showed only elevated FF3 level. （2） The level of serum hCG increased gradually in the first trimester. The medians of hCG were 25 300, 85 220 and 81 780 IU/L 6, 8-10 and 12 weeks after gestation, respectively （P = 0.000）. The medians of serum TSH were 1.45, 1.10 and 0. 84 mIU/L 6, 8-10 and 12 weeks after gestation, respectively （ P 〈 0. 01 ）. （3） When serum hCG was more than 50 000 IU/L, the prevalece of GTT increased obviously. When serum hCG was between 80 000 IU/L and 110 000 IU/L, subclinical GTT increased significantly. When serum bCG was more tban 110 000 IU/L, overt GTT increased significantly. Correlation analysis showed that serum hCG was related negatively with TSH （ r = - 0. 402, P = 0. 000） and positively with FT3 （ r = 0. 165, P = 0. 000）, but not related with FT4. Conclusions The prevalence of GTT is 7. 86% in the first trimester and it is the main cause of thyrotoxicosis found in the first trimester, accounting for 80. 77% of all the causes. The serological characteristic of overt GTT is mainly the elevation of serum FT3 level. Serum hCG level is related with the severity of GTT.

关 键 词：甲状腺毒症 妊娠初期 绒毛膜促性腺激素 

分 类 号：R686[医药卫生—骨科学]