不同诊断标准下妊娠期亚临床甲状腺功能减退与不良妊娠结局的相关性研究  

Correlation between subclinical hypothyroidism and outcome of pregnancy with different diagnostic criteria

作　　者：王小菊[1] 龙燕[1] 蔺莉[2] WANG Xiao-ju;LONG Yan;LIN Li(Department of Gynecology and Obstetrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Obstetrics,Peking University International Hospital,Beijing 102206,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 [2]北京大学国际医院产科,北京102206

出　　处：《临床和实验医学杂志》2019年第11期1194-1198,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市卫生局首发基金资助项目(编号:2016-1-1113)

摘　　要：目的比较不同诊断标准下妊娠期亚临床甲状腺功能减退(SCH)的患病率,探讨不同诊断标准下妊娠期SCH与不良妊娠结局的相关性。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5 554例进行前瞻性队列研究。于妊娠第8~10周行甲状腺过氧化物酶抗体(TPOAb)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。并随访至分娩,收集妊娠期糖尿病、妊娠期高血压疾病、胎盘早剥、前置胎盘、早产、产后出血、巨大胎儿、低出生体重儿等不良妊娠结局资料。比较不同诊断标准下SCH的发生率及妊娠期SCH与不良妊娠结局的相关性。结果按照本单位标准、2011年美国甲状腺学会(ATA)标准和2017年ATA标准分别研究SCH的患病率如下:妊娠期SCH患病率分别为8.96%(498/5 554)、26.53%(1 474/5 554)、7.67%(426/5 554);按照本单位标准和2017年ATA标准诊断的SCH伴TPOAb阳性组的低出生体重儿的发生率显著高于甲状腺功能正常组(8.77%vs.6.22%;9.52%vs.6.32%,P<0.05);按照本单位标准和2017年ATA标准诊断的SCH伴TPOAb阳性组的巨大胎儿的发生率显著高于甲状腺功能正常组(8.77%vs.6.80%;9.95%vs.7.03%,P<0.05);按照2011年ATA标准诊断的SCH TPOAb阳性组、SCH TPOAb阴性组与甲状腺功能正常组比较,妊娠结局差异均无统计学意义(P>0.05)。结论建议本单位妊娠期特异性参考值或以TSH>4.0 m IU/L作为的参考值上限诊断妊娠期SCH;大多数妊娠期SCH发生于孕早期和孕中期;妊娠期SCH与巨大胎儿及低出生体重儿的发生存在相关性。Objective To calculate and compare the prevalence of subclinical hypothyroidism with different diagnostic criteria and to analyze the correlation between subclinical hypothyroidism and adverse pregnancy outcomes.Methods This prospective cohort study included 5 554 women from the department of obstetrics and gynecology,Beijing Friendship Hospital,Capital Medical University during March 2016 to October2017.Thyrotropin(TSH),free thyroxine(FT4),and thyroid peroxidase antibody(TPOAb)were measured in 8-10 gestational weeks.Thyroid function(TSH,FT4)were examined in 24-26 and 36-37 gestational weeks.The outcome measured in follow up period was the incidence of pregnancy-induced hypertension,gestational diabetes mellitus,caesarean section,placental abruption,placenta previa,low birth weight,preterm,macrosomia.The risk of adverse pregnancy outcomes were compared with different diagnostic criteria in subclinical hypothyroidism women.The prevalence of subclinical hypothyroidism with different diagnostic criteria were calculated and correlation between subclinical hypothyroidism and pregnancy outcome during pregnancy was analyzed.Results According to the upper limit of trimester-specific TSH reference range by the hospital,specific reference range of thyroid function during pregnancy by 2011 ATA and 2017 ATA guidelines,the incidences of subclinical hypothyroidism,were 8.96%(498/5 554),26.53%(1 474/5 554)and 8.96%(498/5 554),respectively.There was significantly higher incidence in low birth weight among TPOAb-positive subclinical hypothyroidism(SCH)group diagnosed by the upper limit of trimester-specific TSH reference range upper by the hospital and specific reference range of thyroid function during pregnancy by the 2017 ATA guideline recommending compared to euthyroid women(8.77%vs.6.22%;9.52%vs.6.32%,P<0.05).There were significantly higher incidence at macrosomia among TPOAb-positive SCH group diagnosed by the upper limit of trimester-specific TSH reference range of the hospital and specific reference range of thyroid funct

关 键 词：妊娠期 亚临床甲状腺功能减退 诊断标准 不良妊娠结局 相关性研究 

分 类 号：R714.256[医药卫生—妇产科学]