先兆子痫中24h尿蛋白定量对甲状腺激素水平的影响  

Impact of Quantitative 24-hour Urine Protein on Thyroid Hormone Levels in Patients with Severe Preeclampsia

作　　者：周佳任[1] 杜鹃[1] 乔宠[1] 尚涛[1] 马冰[2] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110001 [2]中国医科大学附属第一医院临床流行病学室,沈阳110001

出　　处：《中国医科大学学报》2014年第5期418-421,425,共5页Journal of China Medical University

基　　金：辽宁省自然科学基金(20082096)

摘　　要：目的探讨先兆子痫中24 h尿蛋白定量对甲状腺激素水平的影响,阐明重度尿蛋白对先兆子痫伴发甲状腺功能减退的影响。方法选择先兆子痫患者166例,按其24 h尿蛋白定量检测结果分为尿蛋白轻度组（2.0～4.9 g/d,简称为轻度组）、尿蛋白中度组（5～10 g/d,简称为中度组）和尿蛋白重度组（＞10 g/d,简称为重度组）。随机抽取同期孕周、年龄匹配的血压正常、尿常规蛋白阴性、无产科合并症的健康孕妇268例为正常对照组。采用化学发光微粒免疫分析技术测定促甲状腺激素（TSH）、血清游离三碘甲腺原氨酸（FT3）和血清游离甲状腺素（FT4）水平,采用化学发光法测定甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）,采用免疫比浊法检测24 h尿蛋白定量。结果轻度组、中度组、重度组3组与正常对照组比较,重度组与轻度组比较,TSH水平均明显升高（P〈0.01）,FT4及FT3水平均明显降低（P〈0.01或0.05）。重度组与中度组比较,FT4水平明显降低（P〈0.05）。轻度组与中度组比较,TPOAb阳性率明显升高（OR=9.8,P〈0.05）,TGAb阳性率无明显变化（P＞0.05）。重度组与轻度组、正常对照组比较,亚临床甲减发生率和临床甲减发生率均显著升高（分别为OR=2.5,P〈0.05;OR=9.0,P〈0.05和OR=8.0,P〈0.01;OR=43.4,P〈0.01）。结论先兆子痫患者中24 h尿蛋白定量影响甲状腺激素水平,TSH水平随尿蛋白定量增加而升高,FT4随尿蛋白定量的增加而降低。TPOAb阳性对24 h尿蛋白定量有影响。先兆子痫患者甲状腺功能减退发生率随24 h尿蛋白定量的增加而增加。尿蛋白是先兆子痫患者发生甲状腺功能减退的危险因素,应重视先兆子痫患者24 h尿蛋白定量的反复监测。Objective To study the effects of quantitative 24-hour urinary protein on the thyroid hormone levels in patients with severe preeclampsia,and clarify the impact of severe urinary protein on hypothyroid in severe preeclampsia patients. Methods A total of 166 patients with severe preeclampsia were recruited for the study and divided into mild proteinuria group（2.0-4.9 g/d）,midrange group（5-10 g/d）and severe group（10 g/d）according to the quantitative 24-hour urinary protein. 268 healthy female individuals with normal blood pressure and uric routine in the same stage of pregnancy and of the same age were selected into control group. Serum thyrotropin（TSH）,free triiodothyronine（FT3）and free thyroxine（FT4）levels were determined by solid-phase chemiluminescent enzyme immunoassay method（CMIA）. The thyroid peroxidase antibody（TPOAb）and thyroglobulin antibody（TGAb）concentration were detected by electrochemiluminescent assay（ECLIA）. Results TSH levels were significantly higher in patients comparing to the control group（P〈0.01）. In addition,severe group showed higher TSH levels than mild group（P〈0.01）. FT4and FT3levels were obviously decreased with the progression of the disease（P〈0.01 and P〈0.05）. The positive rate of TPOAb in mild group was significantly higher than that in moderate group（OR =9.8,P〈 0.05）. There was no significant difference of the TGAb positive rate among three patient groups（P〉0.05）. The incidence of subclinical hypothyroidism and clinical hypothyroidism in severe group was significantly higher than that in mild group and in control group（OR =2.5,P〈0.05 and OR =9.0,P〈0.05;OR =8.0,P〈0.01and OR =43.4,P〈0.01）. Conclusion Our results indicated that 24-hour urine protein in severe preeclampsia patients has extensive effects on thyroid hormones levels. With the increasing of quantitative 24-hour urinary protein,the level of TSH increased and the FT4 decreased. Thyroidautoantibody positiveness has extensive effects on 24-hour ur

关 键 词：先兆子痫 甲状腺功能减退 甲状腺激素 24H尿蛋白定量 

分 类 号：R714.24[医药卫生—妇产科学]