妊娠晚期正常范围内血清促甲状腺激素水平升高对不良妊娠结局的影响及其相关因素分析  

Correlation between Elevated Serum Thyroid Stimulating Hormone Levels in the Normal Range of Late Pregnancy and Adverse Pregnancy Outcomes

作　　者：佘广彤 王慧艳 孙彩凤 王银瓶 SHE Guangtong;WANG Huiyan;SUN Caifeng(Department of Obstetrics,Changzhou Woman and Children Health-care Hospital Affiliated to Nanjing Medical University,Changzhou Jiangsu 213016,China)

机构地区：[1]南京医科大学附属常州妇幼保健院产科

出　　处：《实用妇产科杂志》2020年第2期141-144,共4页Journal of Practical Obstetrics and Gynecology

基　　金：南京医科大学科技发展基金重点项目(编号:NJMUZD080)

摘　　要：目的:探讨妊娠晚期正常范围内血清促甲状腺激素(TSH)升高对不良妊娠结局的影响,以及影响TSH升高的相关因素。方法:通过对2977例甲状腺功能正常孕妇进行回顾性研究,按四分位法根据血清TSH值从低到高分为4组(N1组、N2组、N3组、N4组),比较4组患者的一般情况、血压及妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、早产、产后出血、巨大儿、妊娠期肝内胆汁淤积症的发生率,并分析影响TSH升高的相关因素。结果:4组孕妇年龄、孕周、体质量指数、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)比较差异无统计学意义(P>0.05)。4组孕妇收缩压、舒张压比较差异有统计学意义(P<0.05);N1组收缩压低于N3、N4组,N2组收缩压低于N3组;N1组舒张压低于N3、N4组,N2组低于N3、N4组,差异均有统计学意义(P<0.05)。4组妊娠期高血压疾病、妊娠期糖尿病、早产、产后出血、巨大儿的发生率差异无统计学意义(P>0.05),4组胎膜早破、妊娠期肝内胆汁淤积症的发生率差异有统计学意义(P<0.05)。多元线性回归分析示TSH水平与孕周、舒张压呈正相关(β系数0.043、0.102,P<0.05)。结论:妊娠晚期正常范围内血清TSH水平可能与收缩压、舒张压、胎膜早破、妊娠期肝内胆汁淤积症有关。正常范围的TSH水平随孕周增加及舒张压的上升而升高。Objective:To investigate the effect of elevated thyroid stimulating hormone(TSH)in the normal range in the third trimester of pregnancy on adverse pregnancy outcomes,and the related factors affecting TSH elevation.Methods:2977 pregnant women withnormal thyroid function were retrospectively enrolled in this study.All of the patients were divided into four groups by the quarterback method according to the level of serum TSH(N1 group,N2 group,N3 group,N4 group).The general conditions of patients,blood pressure and the incidence of hypertensive disorder of pregnancy,gestational diabetes,premature rupture of membranes,preterm labor,postpartum hemorrhage and macrosomia,intrahepatic cholestasis during pregnancy were compared in four groups and the related factors influencing the elevation of TSH were analyzed.Results:There were no statistically significant differences in age,gestational week,body mass index(BMI),free thyroxine(FT4),thyroid peroxidase antibody(TPOAb)among the four groups(P>0.05).There were statistically significant differences in systolic and diastolic blood pressure among the four groups(P<0.05).The systolic blood pressure in N1 group was lower than that in N3,N4 group.The systolic blood pressurein N2 group was lower than that in N3 group.The diastolic blood pressure in N1 group was lower than that in N3,N4 group.The diastolic blood pressure in N2 group was lower than that in N3,N4 group(P<0.05).There were no statistically significant differences in the incidence ofhypertensive disorder of pregnancy,gestational diabetes,preterm labor,postpartum hemorrhage and macrosomia(P>0.05).There were statistically significant differences in the incidence of premature rupture of membranes and intrahepatic cholestasis during pregnancy(P<0.05).Multiple linear regression analysis showed a positive correlation between gestational weeks,diastolic blood pressure and TSH level(Beta coefficient=0.043、0.102,P<0.05).Conclusions:Normal high value of TSH in the third trimester maybe relate to the increased systolic and diasto

关 键 词：血清促甲状腺激素 收缩压 舒张压 不良妊娠结局 

分 类 号：R714[医药卫生—妇产科学]