妊娠早中晚期甲状腺功能减退症筛查及其妊娠结局初步分析  

Relationship between screening of gestation specific hypothyroidism and pregnancy outcome

作　　者：黄瑞萍[1] 王秋伟[1] 虞斌[1] 朱自强[1] 曹芳[1] 孙达成[1] 周红[1] 张一鸣[1] 

机构地区：[1]南京医科大学附属常州妇幼保健院生殖医学实验室,江苏常州213003

出　　处：《中国现代医学杂志》2011年第28期3562-3565,共4页China Journal of Modern Medicine

基　　金：常州市卫生局科研基金(No:2008-007)

摘　　要：目的获得妊娠早中晚期妇女甲状腺功能减退症(甲减)及相关的甲状腺异常的患病率,探讨其与不良妊娠结局的相关性。方法以孕期及非孕期甲状腺功能正常范围两种标准分别筛查甲减。应用电化学发光免疫分析法测定TSH、FT4和TPOAb,随访妊娠结局。结果妊娠早中晚期孕妇分别筛查446、684及841例:甲减的患病率分别为0.45%、0.15%和0%;亚临床甲减的患病率分别2.69%、3.07%和5.11%;低T4血症的患病率分别为1.79%、2.34%和2.02%。如按非孕标准:则孕早期甲减、亚临床甲减及低T4血症的漏诊率分别为0.22%、1.79%和0.67%。亚临床甲减及低T4血症组不良妊娠结局发生率分别为57.89%和51.22%,明显高于甲功正常组的18.78%(P<0.01)。结论有必要按妊娠期标准对孕妇开展甲减筛查;甲减及相关的甲状腺异常与妊娠期高血压疾病等并发症明显相关。【Objective】To get the hypothyroidism,subclinical hypothyroidism and low T4 hyperlipidemia rate of the trimester-specific normal childbearing-age-women who lived in Changzhou.【Methods】Both gestational age specific reference intervals and population based reference intervals of thyroid function were applied to screening the hypothyroidism.The survey object were 1 971 pregnant women and there are 446 in the T1 stage（4～12 W）,684 in the T2 stage（12～28 W）,841 in the T3 stage（28～40 W） among the total.Thyroid-stimulating hormone（TSH）,the free T4（FT4） and the autoantibodies against TPO（TPOAb） were measured by chemistry radiation method.Pregnancy outcome was followed-up using the medical record.【Results】In the T1,T2,T3 period of pregnant women,the case rate of clinical hypothyroidism was 0.45%,0.15%,0%.The case rate of subclinical hypothyroidism was 2.69%,3.07%,5.11%,the case rate of low T4 hyperlipidemia respectively were 1.79%,2.34%,2.02%.On the basis of non-pregnant reference range,the missed diagnosis rates of hypothyroidism,subclinical hypothyroidism and low T4 hyperlipidemia was 0.22%,1.79%,0.67% respectively.The adverse pregnancy outcome rate of subclinical hypothyroidism and low T4 hyperlipidemia was 57.89%,51.22% respectively,being significantly higher than normal thyroid function group,which were 18.78%（P 0.01）.【Conclusion】It＇s necessity to screen hypothyroidism,according to gestational age specific reference intervals;Hypothyroidism,and its related thyroid abnormalities are associated with the complication such as gestational hypertension.

关 键 词：甲状腺功能减退症 妊娠 筛查 并发症 

分 类 号：R714[医药卫生—妇产科学]