青岛地区妊娠前半期妇女甲状腺功能减退症的筛查  

Screening of Hypothyroidism of Women during the First Half of Pregnancy in Qingdao

作　　者：张晶[1] 彭伟[1] 左建新[1] 徐琳[1] 王娈[1] 赵文娟[1] 

机构地区：[1]青岛大学医学院,山东青岛266000

出　　处：《现代生物医学进展》2013年第11期2126-2130,共5页Progress in Modern Biomedicine

摘　　要：目的:了解青岛地区妊娠前半期(即妊娠≤20周)妇女甲状腺功能减退症的患病率。方法:选取338例妊娠前半期妇女和非妊娠妇女94例,检测血清TSH、FT4、TPOAb水平,以妊娠特异性甲状腺功能指标参考范围和非妊娠妇女甲状腺功能参考范围作为评价标准,筛查妊娠前半期妇女的甲状腺功能减退症的患病率。结果:采用妊娠期特异性甲状腺功能正常参考范围诊断妊娠8周临床甲减的患病率为1.71%;妊娠8周、12周、16周、20周亚临床甲减的患病率分别为4.00%、3.17%、2.27%、3.57%;低T4血症的患病率分别为6.29%、4.76%、2.27%、10.71%。采用非妊娠女性甲状腺功能正常参考范围作为评价标准,妊娠8周临床甲减的漏诊率为1.14%;妊娠8周、12周、16周、20周亚临床甲减的漏诊率分别为2.29%、1.59%、2.27%、3.57%;低T4血症在妊娠8周、12周的漏诊率为4.00%、3.17%,在妊娠16周、20周的误诊率为22.73%、33.93%。妊娠8周亚临床甲减组TPOAb阳性率明显高于甲状腺功能正常组,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参考范围为标准,能够降低妊娠前半期妇女亚临床甲减的漏诊率和低T4血症的误诊率。TPOAb阳性是亚临床甲减发生的主要危险因素之一。Objective： To observe the occurrence of hypothyroidism during the first half of pregnancy in women in Qingdao. Methods： 338 pregnant women and 94 non-pregnant women were collected. Urinary iodine excretion and serum thyrotropin（TSH）,Free thyroxine （FT4）, thyroid peroxidase antibody （TPOAb） levels were determined in all subjects. Both gestational age-specific reference intervals and population-based reference intervals of thyroid function were applied and the corresponding prevalences of hypothyroidism were compared with each other. Reatlts： Based on the pregnant age-specific reference intervals, the prevalence of overt hypothyroidism at 8th weeks of gestation was 1.71%; at 8th,12th,16th and 20th weeks of gestation, the prevalences of subclinical hypothyroidism were 4.00%, 3.17%, 2.27%,3.57%, respectively; the prevalences of hypothyroxinemia were 6.29%, 4.76%, 2.27%, 10.71%, respectively. According to the non-pregnant reference intervals, during the 8th weeks of gestation, the rates of missed diagnosis of overt hypothyroidism was 1.14%. The rates of missed diagnosis of the subclinical hypothyroidism were 2.29%, 1.59%, 2.27%,3.57% at 8th, 12th, 16th and 20th weeks of gestation, respectively. The rate of missed diagnosis hypothyroxinemia was 4.00% at the 8th weeks of gestation and 3.17% at 12th weeks of gestation. The miagnosis rates of hypothyroxinemia were 22.73% and 33.93% at 16th and 20th weeks of gestation. At 8th 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. Conclusion： According to the gestational month-specific reference intervals can decrease the rate of missed diagnosis of subclinical hypothyroidism and the misdiagnosis rate of hypothyroxinemia. Positive TPOAb is one of the risk factors for subclinical hypothyroidism.

关 键 词：妊娠 甲状腺功能减退症 低T4血症 甲状腺过氧化物酶抗体 

分 类 号：R581.2[医药卫生—内分泌] R714.147[医药卫生—内科学]