妊娠期甲状腺功能减退症女性产后甲状腺功能转归影响因素分析  

Correlation Analysis of Influencing Factors of Postpartum Thyroid Function in Women with Abnormal Thyroid Function During Pregnancy

作　　者：全紫薇[1] 蔺莉[2] 龙燕[1] 王小菊[1] 崔鑫 金华[1] Quan Ziwei;Lin Li;Long Yan(Department of Obstetrics and Gynecology,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,100050 [2]北京大学国际医院妇产科,102206

出　　处：《医学研究杂志》2020年第9期67-71,共5页Journal of Medical Research

基　　金：首都卫生发展科研专项基金资助项目(2016-1-1113)。

摘　　要：目的分析妊娠期甲状腺功能减退症(以下简称甲减)女性产后甲状腺功能转归的相关影响因素。方法选择2012年1月~2017年12月期间,在首都医科大学附属北京友谊医院产检并分娩的产妇。按照笔者医院制定的妊娠期甲状腺功能特异参考标准,将妊娠期诊断的亚临床甲减、低T4血症、甲状腺自身抗体阳性的产妇作为研究对象,共纳入870例。分娩后42天、3个月、6个月、1年、2年进行随访。观察甲状腺功能的变化。其中对妊娠期亚临床甲减产妇根据TPOAb情况分为妊娠期亚临床甲减+TPOAb阳性组及妊娠期亚临床甲减+TPOAb阴性组,前者孕期和产后全部给予左旋甲状腺素钠片治疗。按其产后治疗时间分为持续治疗0~6个月组及>6个月组,观察其产后甲状腺功能减退的患病情况。结果影响产后甲状腺功能转归的相关因素:单因素Logistic回归分析影响妊娠期亚临床甲减+TPOAb阳性组患者产后甲状腺功能转归的因素为TPOAb效价、产后药物干预及甲状腺摄碘率;影响低T4血症+TPOAb阳性组产后甲状腺功能转归的因素为TPOAb效价和甲状腺摄碘率;影响单纯甲状腺自身抗体阳性患者产后甲状腺功能转归的因素为TPOAb效价及诊断孕周。多因素Logistic回归分析显示,TPOAb效价(>1000U/ml)是妊娠期亚临床甲减+TPOAb阳性、低T4血症、单纯甲状腺自身抗体阳性组患者产后发生甲状腺功能减退的独立高危因素;产后药物干预是亚临床甲减患者产后发生甲状腺功能减退的独立保护因素。结论产后持续治疗是影响妊娠期亚临床甲减合并TPOAb阳性患者产后甲状腺功能转归的独立保护因素。妊娠期亚临床甲减和低T4血症合并TPOAb阳性患者和单纯甲状腺自身抗体阳性患者的TPOAb效价高低是影响产后甲状腺功能转归的独立高危因素。Objective To analyze the related factors of postpartum thyroid function of the long-term outcome of postpartum thyroid function in women with abnormal thyroid function during pregnancy.Methods Totally 870 pregnant women who underwent prenatal examination and delivery in the Department of Obstetrics and Gynecology of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2017 were enrolled in the study.It was divided into subclinical hypothyroidism,hypothyroxinemia,and thyroid of pregnancy diagnosis.The autoantibody was positive,and 870 cases were included in the study.All the pregnant women were followed up for 42 days,3 months,half a year,1 years,and 2 years after delivery.Among them,pregnant women with subclinical hypothyroidism were divided into TPOAb positive group and TPOAb negative group according to TPOAb condition.All patients with subclinical subclinical hypothyroidism and TPOAb positive group were treated with levothyroxine sodium tablets.According to their continuous treatment time,the patients were divided into continuous treatment 0-6 months group and continuous treatment>6 months group,and the postpartum thyroid related diseases were observed.The difference in the incidence of disease.Results The related factors influencing the postpartum thyroid function outcome:single factor Logistic regression analysis influence pregnancy SCH+TPOAb factors of postpartum thyroid function in patients with positive outcomes for TPOAb drop degree,postpartum drug intervention and thyroid iodine taken rate.TPOAb titer and thyroidic iodine rate were the factors that affected the postpartum thyroid function in patients with low T4 and TPOAb positive group.The factors that affect the postpartum thyroid function in patients with pure thyroid autoantibodies are TPOAb titer and the diagnosis of gestational weeks.Multiariable Logistic regression analysis showed that degree of TPOAb drops(>1000U/ml)was SCH+TPOAb positive during pregnancy,low T4 concentration,pure thyroid autoantibody

关 键 词：妊娠期亚临床甲状腺功能减退 低T4血症 甲状腺过氧化氢酶 甲状腺球蛋白抗体 药物干预 

分 类 号：R71[医药卫生—妇产科学]