甲状腺自身抗体与妊娠期甲状腺功能异常的相关性研究  

Study on the correlation between incidence of thyroid dysfunction and thyroid autoimmune antibodies during pregnancy

作　　者：王小菊[1] 龙燕[1] 蔺莉[1] WANG Xiao-ju;LONG Yan;LIN Li(Department of Gynecology & Obstetrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院妇产科,北京100050

出　　处：《临床和实验医学杂志》2019年第8期870-874,共5页Journal of Clinical and Experimental Medicine

基　　金：首都卫生发展科研专项项目(编号:2016-1-1113)

摘　　要：目的探讨甲状腺自身抗体与妊娠期甲状腺功能异常的相关性。方法选择2016年3月至2017年10月在首都医科大学附属北京友谊医院妇产科门诊首次就诊并建立围产保健档案的妊娠妇女共4 399例进行前瞻性研究。于妊娠第8~10周行甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)和甲状腺功能(TSH、FT4)的测定;于妊娠第24~26周、妊娠第36~37周行甲状腺功能(TSH、FT4)的测定。根据妊娠期特异性参考值范围对妊娠期甲状腺功能异常进行诊断。计算早孕期妇女甲状腺自身抗体的阳性率,并分析甲状腺自身抗体阳性对妊娠期甲状腺功能异常发生率的影响。结果纳入的4 399例研究对象中,TPOAb阳性率为12. 0%(529/4 399); TGAb阳性率为9. 1%(399/4 399); TPOAb和TGAb均阳性孕妇占总人数的5. 0%(220/4 399)。TPOAb阳性和TGAb阳性孕妇妊娠期临床、亚临床甲状腺功能减退症和低T4血症的发生率分别为3. 0%、9. 3%、3. 8%和5. 0%、11. 0%、3. 5%; TPOAb和TGAb均阳性妇女中上述三种甲状腺功能异常的发生率分别为6. 8%、10. 9%、4. 5%。三组与TPOAb和TGAb抗体均阴性者比较差异均具有统计学意义(P <0. 05)。TPOAb阳性(OR值分别为4. 79、12. 9、1. 91,P <0. 05)、TGAb阳性(OR值分别为5. 76、38. 4、1. 77,P <0. 05)、TPOAb和TGAb均阳性(OR值分别为5. 07、31. 1、2. 4,P <0. 05)均显著增加妊娠期临床、亚临床甲状腺功能减退症、低T4血症的发生风险。TPOAb阳性、TGAb阳性、TPOAb和TGAb均阳性组与TPOAb和TGAb抗体均阴性者比较妊娠期临床、亚临床甲状腺功能亢进症、高T4血症的发生率差异均无统计学意义(P> 0. 05)。结论甲状腺自身抗体阳性妇女妊娠期发生甲状腺功能异常的风险明显增加。对甲状腺自身抗体阳性妇女加强甲状腺功能筛查对诊断和治疗妊娠期甲状腺功能异常有重要价值。Objective To explore the correlation between incidence of thyroid dysfunction and thyroid autoimmune antibodies during pregnancy.Methods This is a prospective study.A total of 4 399 women from the Department of Obstetrics and Gynecology in this hospital are included.TPOAb and TGAb were examined at 8-10 gestational weeks.Thyroid functions(TSH,FT 4)were examined in 8-10,24-26 and 36-37 gestational weeks by chemilumino-metric immunoanalysis.Thyroid dysfunction was diagnosed by using gestational age-specific interval for TSH and FT 4.The prevalence of positive TPOAb and TGAb were calculated and the correlation between incidence of thyroid dysfunction and positive thyroid autoimmune antibodies during pregnancy were analyzed.Results The rate of positive TPOAb was 12.0%(529/4399).The rate of positive TGAb was 9.1%(399/4399).The positive rate of both TPOAb and TGAb was 5.0%(220/4399).The incidence of clinical hypothyroidism,subclinical hypothyroidism and hypothyroxinemia in TPOAb-positive and TGAb-positive women were 3.0%,9.3%,3.8%and 5.0%,11.0%,3.5%,respectively.The incidence rates of clinical hypothyroidism,subclinical hypothyroidism and hypothyroxinemia in women with both TPOAb and TGAb positive were 6.8%,10.9%,and 4.5%respectively.There was statistically significant difference between thyroid autoimmune antibodies positive group and control group(P<0.05).TPOAb-positive(OR values are 4.79,12.9 and 1.91,P<0.05),TGAb-positive(OR values were 5.76,38.4 and 1.77,P<0.05),TPOAb and TGAb positive(OR values were 5.07,31.1 and 2.4,P<0.05)are risk factors for hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia during pregnancy.There was no significant difference in the incidence of hyperthyroidism in pregnant women with thyroid autoimmune antibodies compared with those with antibody negative group(P>0.05).Conclusion Women with positive thyroid autoimmune antibodies have significantly increased risk for developing thyroid dysfunction during pregnancy.The screening of thyroid function in women with autoimmune antibodies

关 键 词：妊娠期 甲状腺功能异常 甲状腺自身抗体 

分 类 号：R714.256[医药卫生—妇产科学]