妊娠前半期诊断及左旋甲状腺素治疗对甲状腺功能减退孕妇妊娠结局的影响  

Effects of diagnosis during the first half of pregnancy and levothyroxine therapy on pregnancy outcomes in hypothyroidism pregnant women

作　　者：苗明珠[1] 唐剑娇 王珏[1] 朱媛媛 袁庆新[2] 晋柏[1] MIAO Mingzhu;TANG Jianjiao;WANG Jue;ZHU Yuanyuan;YUAN Qingxin;JIN Bai(Department of Obstetrics,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院产科,江苏南京210029 [2]南京医科大学第一附属医院内分泌科,江苏南京210029

出　　处：《皖南医学院学报》2022年第5期460-463,共4页Journal of Wannan Medical College

基　　金：江苏省妇幼健康科研项目(F201704)。

摘　　要：目的:建立本单位妊娠前半期特异性甲状腺功能参考范围,并探讨妊娠期治疗及未治疗甲状腺功能减退对妊娠结局的影响。方法:按照美国临床生化研究院标准,纳入2018年6月~2019年10月在南京医科大学第一附属医院产检的孕妇902例,分为早期组(孕6~12^(+6)周)、中期组(孕13~20周)。测定其TSH和FT4,建立妊娠特异性甲状腺功能参考范围。分别以此标准和非孕标准对同期在本院分娩并于妊娠20周前在本院检测过甲状腺功能的3754例孕妇的甲状腺功能减退进行回顾性诊断并分析其妊娠结局。结果:①建立了本单位妊娠前半期特异性甲状腺功能参考范围,即早期(6~12^(+6)周)TSH为0.22~3.83 mU/L,FT4为13.89~21.35 pmol/L;中期(13~20周)TSH为0.58~3.71 mU/L,FT4为11.42~18.81 pmol/L。②甲状腺功能减退(临床甲状腺功能减退和亚临床甲状腺功能减退)的总体患病率,新建立的标准高于非孕标准(7.7%vs.5.2%,χ^(2)=19.590,P<0.001);而单纯性低FT4血症则相反(10.4%vs.17.1%,χ^(2)=70.603,P<0.001)。③漏诊甲状腺功能减退孕妇的流产和早产发生率较甲状腺功能正常组增高(13.5%vs.6.8%,P<0.05),3组间妊娠期高血压疾病和妊娠期糖尿病(GDM)的发生率差异均无统计学意义(P>0.05)。结论:采用妊娠前半期特异性甲状腺功能参考值作为新的诊断标准,可降低临床甲状腺功能减退、亚临床甲状腺功能减退的漏诊率,同时降低单纯性低FT4血症的误诊率。早期准确诊断并及时规范治疗能减少妊娠期甲状腺功能减退患者部分不良妊娠结局的发生。Objective:To establish the reference range of trimester-specific thyroid function in the first half of pregnancy in our institution,and investigate the influence of hypothyroidism after treatment on pregnancy outcomes.Methods:According to the standard of National Academy of Clinical Biochemistry,902 pregnant women received prenatal care at our hospital between June 2018 and October 2019 were included,and divided into early pregnancy group(6~12^(+6)weeks)and mid-pregnancy(13-20 weeks)group according to their gestational age.Levels of TSH and FT4 were measured in all women to establish the reference ranges of trimester-specific thyroid function.Then retrospective analysis was performed in 3754 pregnant women of hypothyroidism delivered in the same period and undergone thyroid function test in our hospital before 20 weeks of pregnancy by this standard and non-pregnancy standard for the diagnosis and pregnancy outcomes.Results:①Reference ranges for the trimester-specific thyroid function in the first half of pregnancy in our institution were established as TSH:0.22-3.83 mU/L;FT4:13.89-21.35 pmol/L for early pregnancy,and TSH:0.58-3.71 mU/L;FT4:11.42-18.81 pmol/L for the mid-pregnancy;②The overall prevalence of overt hypothyroidism and subclinical hypothyroidism was higher with established criteria than with non-gestational criteria(7.7%vs.5.2%,χ^(2)=19.590,P<0.001),whereas that of isolated hypothyroxidemia was the opposite(10.4%vs.17.1%,χ^(2)=70.603,P<0.001);③The incidence of miscarriage and preterm delivery in women with missed hypothyroidism was higher than that in patients with euthyroid function(13.5%vs.6.8%,P<0.05).There was no significant difference in the incidence of hypertensive disorders of pregnancy and GDM among the three groups(P>0.05).Conclusion:The use of trimester-specific reference ranges of thyroid function as a new diagnostic standard can cut down missed diagnosis rate of hypothyroidism during pregnancy as well as the misdiagnosis rate of isolated hypothyroxidemia.Early accurate diagnosis a

关 键 词：甲状腺功能 参考值 甲状腺功能减退 左旋甲状腺素 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学] R581.2[医药卫生—临床医学]