妊娠早期单纯TPO-Ab阳性对妊娠不良结局的影响研究  

Study on the effect of single TPO-Ab positive in early pregnancy on adverse pregnancy outcome

作　　者：郑莉霞 姚莉芸 石国素 宋艳宁 赵岗 董淑晓 ZHENG Lixia;YAO Liyun;SHI Guosu;SONG Yanning;ZHAO Gang;DONG Shuxiao(Department of First Obstetrics,Xingtai Third Hospital,Xingtai,Hebei 054000,China)

机构地区：[1]河北省邢台市第三医院产一科,054000

出　　处：《重庆医学》2020年第18期3044-3048,共5页Chongqing medicine

基　　金：河北省邢台市科技计划项目(2017ZC088)。

摘　　要：目的分析妊娠早期单纯甲状腺过氧化物酶抗体(TPO-Ab)阳性对妊娠不良结局的影响。方法选取2018年7-12月定期接受产检的940例孕妇为研究对象,妊娠早期甲状腺功能均正常,于11~13+6周产检时测定血清TPO-Ab水平,单纯TPO-Ab阳性孕妇根据自愿选择是否接受左旋甲状腺素(LT4)治疗分为LT4组和对照组,统计妊娠中晚期甲状腺功能异常及妊娠不良结局情况。结果妊娠早期单纯TPO-Ab阳性孕妇占8.94%(84/940),其中LT4组占58.33%(49/84)。妊娠早期单纯TPO-Ab阳性孕妇妊娠中晚期亚临床甲状腺功能减退症(甲减)、临床甲减患病率明显高于TPO-Ab阴性孕妇(P<0.05),且LT4组妊娠中晚期亚临床甲减、临床甲减患病率明显低于对照组(P<0.05)。与TPO-Ab阴性孕妇比较,单纯TPO-Ab阳性孕妇妊娠期糖尿病、胎膜早破、胎盘异样、流产、早产、巨大儿、有剖宫产指征占比更高,差异有统计学意义(P<0.05)。与对照组比较,LT4组妊娠期糖尿病、胎膜早破、早产、巨大儿、有剖宫产指征占比更低,差异有统计学意义(P<0.05)。结论妊娠早期单纯TPO-Ab阳性可增加妊娠中晚期亚临床甲减、临床甲减及妊娠不良结局风险,LT4替代治疗可降低上述风险。Objective To analyze the influence of single thyroid peroxidase antibody(TPO-Ab)positive in early pregnancy on adverse pregnancy outcome.Methods A total of 940 pregnant women with normal thyroid function in early pregnancy from July to December 2018 were selected.Serum TPO-Ab was measured from 11 to 13+6 weeks.According to the voluntary choice of whether to receive levothyroxine(LT4)treatment,they were divided into the LT4 group and the control group.Observed abnormalities of thyroid function in the middle and late pregnancy and adverse pregnancy outcomes.Results Single TPO-Ab-positive pregnant women in early pregnancy accounted for 8.94%(84/940),and the LT4 group accounted for 58.33%(49/84).The prevalence of subclinical hypothyroidism and clinical hypothyroidism in the middle and late pregnancy for single TPO-Ab-positive pregnant women in early pregnancy was significantly higher than those of TPO-Ab-negative pregnant women(P<0.05),and the prevalence of subclinical hypothyroidism and clinical hypothyroidism in the middle and late pregnancy for the LT4 group was significantly higher than those in the control group(P<0.05).Compared with TPO-Ab-negative pregnant women,single TPO-Ab-positive pregnant women had a higher incidence of gestational diabetes,premature rupture of membranes,placental abnormalities,miscarriage,premature delivery,macrosomia and indicated cesarean section,the difference was statistically significant(P<0.05).Compared with the control group,the incidence of gestational diabetes,premature rupture of membranes,premature birth,macrosomia and indicated cesarean section in the LT4 group were lower,the difference was statistically significant(P<0.05).Conclusion Single positive TPO-Ab in early pregnancy canincrease the risks of subclinical hypothyroidism,clinical hypothyroidism and adverse pregnancy outcomes in the middle and late pregnancy,while LT4 replacement therapy could reduce the above risks.

关 键 词：妊娠初期 孕妇 碘化物过氧化物酶 妊娠并发症 妊娠结局 

分 类 号：R826.2[医药卫生—临床医学]