妊娠前半期甲状腺功能减退症的临床流行病学调查  

An epidemiologic survey of hypothyroidism during the first haft of pregnancy

作　　者：陈彦彦[1] 滕卫平[1] 单忠艳[1] 李晨阳[2] 周卫卫[3] 高波[4] 尚涛[5] 周佳任[5] 丁彬[2] 马英 武英[7] 刘群[8] 刘伟[9] 于晓会[1] 李佳[1] 王薇薇[1] 李元宾[1] 范晨玲[1] 王红[1] 郭锐[1] 张红梅[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]沈阳市第五人民医院妇产科 [3]沈阳市妇婴医院 [4]沈阳市第四人民医院妇产科 [5]中国医科大学附属盛京医院妇产科 [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：《中华内分泌代谢杂志》2008年第6期597-600,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：基金项目：“十五”国家科技攻关计划项目（2004BA720A）;卫生行业科研专项项目（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：目的调查中国汉族碘适量地区正常育龄妇女妊娠前半期甲状腺功能减退症（甲减）的患病率。方法妊娠前半期妇女共4800人入选，测定血清TSH、FT4和甲状腺过氧化物酶抗体（TPOAb）水平。以妊娠期特异性甲状腺功能正常范围和非妊娠人群甲状腺功能正常范围两种标准，分别筛查甲减。结果采用妊娠期特异性甲状腺功能正常范围诊断妊娠4周、8周临床甲减的患病率为1．03％、0．37％，妊娠4周、8周、12周、16周、20周妇女亚临床甲减的患病率分别为4．59％、6．15％、4．68％、4．53％、5．96％；低T4血症的患病率分别为3．69％、1．11％、2．92％、1．29％、2．29％。如采用非妊娠人群诊断标准，则其亚临床甲减的漏诊率分别为0．18％、2．85％、4．10％、3．24％、3．21％；低T4血症的漏诊率分别为3．45％、0．66％、2．34％、1．29％、1．83％。妊娠4周、8周、16周时亚临床甲减组TPOAb阳性率明显高于甲状腺功能正常组；妊娠4周、8周、12周、16周时TPOAb阳性组亚临床甲减的患病率明显高于TPOAb阴性组。结论采用妊娠期特异性甲状腺功能评价指标的正常范围，能够降低妊娠前半期亚临床甲减和低Td血症漏诊率。TPOAb阳性是妊娠前半期亚临床甲减发生的主要危险因素之一。Objective To investigate the prevalence of hypothyrodism during the first half of pregnancy in the HaM nationality women in iodine-adequate area. Methods TSH, FT4 and thyroid peroxidase antibody （TPOAb） levels were detected in 4 800 pregnant women during the first half of pregnancy. Both gestational agespecific reference intervals and population-based reference intervals of thyroid function were applied and the corresponding prevalences of hypothyroidism were compared with each other. Results Based on the gestational age-specific reference intervals, the prevalences of overt hypothyroidism at 4th and 8th weeks of gestation were 1.03%, 0.37% respectively. At 4th, 8th, 12th, 16th and 20th weeks of gestation, the prevalences of subclinical hypothyroidism were 4.59%, 6.15%, 4.68%, 4.53%, 5.96% respectively, while those of hypothyroxinemia were 3.69%, 1. 11%, 2.92%, 1.29%, 2.29%, respectively. According to the population-based reference intervals, the rates of missed diagnosis of subclinical hypothyroidism were 0.18%, 2.85%, 4.10%, 3.24%, 3.21% while those of hypothyroxinemia were 3.45%, 0.66%, 2.34%, 1.29%, 1.83%, respectively. During 4th, 8th, 16th weeks of gestation, the positive rates of TPOAb in the group with subclinical hypothyroidism were significantly higher than those with euthyroidism. The prevalences of subclinical hypothyroidism in TPOAb positive group were obviously higher than those in TPOAb negative group at 4th, 8th, 12th, 16th gestational weeks. Conclusion The rates of missed diagnosis of subclinical hypothyroidism and hypothyroxinemia during the first half of pregnancy were decreased by applying the gestational age-specific reference intervals in this prospective study. Positive TPOAb is a risk factor for subclinical hypothyroidism during the first half of pregnancy.

关 键 词：妊娠 甲状腺功能减退症 低Td血症 甲状腺过氧化物酶抗体 

分 类 号：R714.2[医药卫生—妇产科学] R581[医药卫生—临床医学]