妊娠早期母体甲状腺功能及其抗体异常对妊娠结局的影响  

The impact of maternal thyroid diseases on the pregnant outcome in the first trimester of pregnancy

作　　者：李建新[1] 王森 单忠艳[1] 王薇薇[1] 滕卫平[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科,中国医科大学内分泌研究所,辽宁省内分泌疾病重点实验室,沈阳110001 [2]辽宁省中医药大学附属医院内分泌科

出　　处：《中华内分泌代谢杂志》2011年第11期916-919,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的评估妊娠早期甲状腺疾病与产科并发症关系。方法2517名来自沈阳市10家医院妊娠12周内的妇女，测定血清TSH、FT4、甲状腺过氧化物酶抗体（TPOAb）水平。收集妊娠结局资料，评价妊娠早期TPOAb（＋）、TSH升高或降低以及抗甲状腺药物或左旋甲状腺素钠（L-T4）治疗对产科并发症的影响。结果妊娠早期TSH升高妇女自发性流产发生率增加（8．69％对6．38％，P=0．048），并且亚临床甲状腺功能减退即可显著增加自发性流产发生率（9．50％对6．38％，P=0．009）。TPOAb（＋）组与TPOAb（-）组相比自发性流产发生率无差别（5．22％对7．41％，P=0．204）。Logistic回归分析显示，血清TSH水平升高、妊娠期间被动吸烟、年龄≥30岁均是妊娠期间自发性流产的独立危险因素（分别为OR=1．572，95％CI1．120～2．208；OR=1．432，95％CI1．012～2．025；OR=1．904，95％CI1．245—2．914）。甲状腺功能亢进或甲状腺功能减退药物治疗维持妊娠期间正常甲状腺功能可降低自发性流产的发生。血清TSH水平升高或降低、TPOAb（＋）与其他产科并发症无关。结论妊娠早期血清TSH水平升高是妊娠期自发性流产的危险因素；甲状腺功能亢进或甲状腺功能减退经药物治疗维持妊娠期间TSH在正常范围可降低自发性流产发生率。Objective To evaluate the association between maternal thyroid diseases in the first trimester of pregnancy and obstetric complications. Methods A total of 2 517 pregnant women from 10 hospitals in Shenyang during the first 12 weeks of gestation were enrolled in this study. All sera obtained from pregnant women were measured for thyroid-stimulating hormone（ TSH ）, free thyroxine （FF4 ）, and thyroid peroxidase antibody （TPOAb）. Collected items include obstetric outcomes and complications. Results Serum TSH above 2.5 mlU/L during the first trimester of pregnancy increased the rate of spontaneous abortion （ 8.69% vs 6. 38% , P = 0. 048 ） , even if subclinical hypothyroidism （9.50% vs 6.38 %, P = 0. 009 ）. TSH above the gestational special reference range, passive smoking, and over 30 years were independent factors for increasing the rate of spontaneous abortion. Hyperthyroidism and hypothyroidism with drug treatment to maintain normal thyroid function during pregnancy reduced the incidence of spontaneous abortion. Increased or decreased levels of serum TSH and TPOAb （＋） were not related with other obstetric complications. Conclusion Serum TSH above the gestational special reference range during the first trimester of pregnancy is a risk factor of spontaneous abortion; maintaining TSH within the normal range by treating hyperthyroidism or hypothyroidism may reduce spontaneous abortion rate.

关 键 词：妊娠 甲状腺功能 甲状腺自身抗体 自发性流产 产科并发症 

分 类 号：R714.2[医药卫生—妇产科学]