孕妇血清甲状腺过氧化物酶抗体阳性对妊娠结局的影响  

Influence of positive serum thyroid peroxidase antibody on pregnancy outcomes

作　　者：徐艳红[1] 吴艺捷[1] 罗越 徐先明[2] 申玉红[2] 董玉英[2] 

机构地区：[1]上海交通大学附属第一人民医院内分泌科,200080 [2]上海交通大学附属第一人民医院产科,200080

出　　处：《中华内分泌代谢杂志》2012年第5期377-381,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市卫生局科技发展基金项目（054017）

摘　　要：目的探讨孕妇甲状腺功能正常但血清甲状腺过氧化物酶抗体（TPOAb）阳性对妊娠结局的影响。方法对2006年7月至2010年12月期间在本院进行常规产前检查，既往无甲状腺疾病史和家族史，甲状腺功能正常的孕妇进行血清TPOAb检测，并分为TPOAb阴性组（1417例）及阳性组（185例），比较2组产科并发症、新生儿出生体重及Apgar评分。结果与TPOAb阴性组相比，TPOAb阳性组更容易发生各种产科并发症。其中脐带缠绕（18．9％对12．9％，RR=1．47，95％C11．06-2．03，P〈0．05）、先兆早产／流产（3．8％对1．O％，RR=3．83，95％CI1．57-9．37，P〈0．05）、胎儿宫内发育迟缓（5．4％对0．8％，RR=6．96，95％C13．00-16．17，P〈0．01）和新生儿肺炎（4．9％对1．3％，RR=3．83，95％C11．75-8．40。P〈0．01）等并发症的患病率高于TPOAb阴性组。TPOAb阳性组新生儿1min、5minApgar评分分别为9．274-1．13和9．44±1．09，均低于阴性组（9．49±O．69和9．68±0．52，均P〈0．01），其中5minApgar评分低于7分者较TPOAb阴性组多（1．6％对0．1％，RR=11．49，95％a1．93-68．31，P〈0．05）。结论孕妇甲状腺功能正常但血清TPOAb阳性可导致先兆早产／流产、胎儿宫内发育迟缓、新生儿Apgar评分降低等不良妊娠结局的风险增加。Objective To investigate the influence of positive serum thyroid peroxidase antibody （TPOAb） on pregnancy outcomes in biochemically euthyroid women during gestation. Methods From July 2006 to December 2010, in the prenatal care unit all pregnant women, who had no medical and family history of thyroid diseases, underwent thyroid function screening. Serum TPOAb was tested among those pregnant women with euthyroidism. Pregnancy outcomes, including obstetric complications, neonate birth weight, and Apgar score, were compared between 185 TPOAb positive women and 1 417 TPOAb negative women. Results Compared with TPOAb negative women, it was more frequent for TPOAb positive women to suffer from various obstetric complications. The prevalences of umbilical cord entanglement （ 18.9% vs 12.9%, RR = 1.47, 95% CI 1.06-2.03, P〈0. 05 ）, threatened premature delivery or abortion （3.8% vs 1.0% , RR = 3.83, 95% CI 1.57-9.37, P〈0.05 ）, intrauterine growth retardation （5.4% vs O. 8%, RR = 6.96, 95% C1 3.00-16. 17, P 〈 0.01 ）, and neonatal pneumonia （4.9% vs 1.3% , RR=3. 83, 95% CI 1.75-8. g0, P〈0.01 ） in the group of TPOAb positive women were higher than those in the group of TPOAb negative women. Apgar score of those newborns whose mothers had positive TPOAb was 9.27±1.13 at one minute and 9.44±1.09 at five minutes, being lower than that of the TPOAb negative group （ 9.49±0.69 and 9.68±.52, both P〈0.01 ）. The rate of newborns with Apgar score at 7 or less by 5 min in group with positive TPOAb was higher than that of group with negative TPOAb （ 1.6% vs O. 1% , RR= 11.49, 95% CI 1.93-68.31, P〈 0.05 ）. Conclusions These results indicate that pregnant women with normal thyroid function but positive TPOAb may be liable to increase risk of serious pregnancy outcomes, such as threatened premature delivery or abortion, intrauterine growth retardation, and a lower Apgar score in neonatal.

关 键 词：孕妇 甲状腺过氧化物酶抗体 产科并发症 APGAR评分 

分 类 号：R446.1[医药卫生—诊断学]