妊娠合并甲状腺功能减退对自然流产的影响因素研究  

Study on the influential factors of pregnancy with hypothyroidism on spontaneous abortion

作　　者：彭茸[1] 赖雪梅[1] 任钧[1] 何丹[1] PENG Rong;LAI Xuemei;REN Jun;HE Dan(Department of Obstetrics and Gynecology,Chongqing Health Center For Women and Children(Women and Children's Hospital of Chongqing Medical University),Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)妇产科,重庆401147

出　　处：《中国妇产科临床杂志》2023年第2期167-170,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：重庆市渝中区技术预见与制度创新项目(20210108);重庆市科卫联合面上项目(2021MSXM247)。

摘　　要：目的探讨妊娠合并临床甲状腺功能减退(overt hypothyroidism,OH)和亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)对自然流产的影响。方法前瞻性纳入妊娠合并甲状腺功能减退症患者284例为研究对象,根据妊娠4~12周不同甲状腺功能检查结果分为OH组104例(TSH>3.6 mIU/L且血清游离甲状腺素(FT_(4))<11.49 pmol/L)和SCH组180例(TSH>3.6 mIU/L且FT_(4)在11.49~18.84 pmol/L);另抽签法随机抽取同期150例甲状腺功能正常孕妇作为对照组。OH组和SCH组无论抗甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)是否阳性,明确诊断后立即予以左旋甲状腺素钠(levothyroxine,L-T_(4))治疗,达到孕早期TSH<2.5 IU/L后维持L-T_(4)剂量。比较三组妊娠28周时妊娠结局影响因素。结果OH组干预后自然流产率[13.46%(14/104)]与干预前[35.58%(37/104)]比较,差异有统计学意义(P<0.001);SCH组干预后自然流产率[10.00%(18/180)]与干预前[34.44%(62/180)]比较,差异有统计学意义(P<0.001);对照组自然流产率[8%(12/150)]与既往自然流产率[7.33%(11/150)]比较,差异无统计学意义(P=0.828);OH组、SCH组和对照组干预后自然流产率比较,差异均无统计学意义(P=0.375);单因素分析显示,妊娠≤8周筛查、抗甲状腺过氧化物酶抗体(TPOAb)阳性、年龄(≥30岁)、既往自然流产史、多次妊娠史和不孕史等因素中,仅妊娠≤8周筛查有统计学意义(P<0.001)。结论妊娠合并OH和SCH患者,不论TPOAb是否阳性,均建议立即使用L-T_(4);妊娠8周以前筛查和治疗可能是影响自然流产的时间窗。Objective To investigate the effects of pregnancy with overt hypothyroidism(OH)and subclinical hypothyroidism(SCH)on spontaneous abortion.Methods 284 cases of pregnancy with hypothyroidism were prospectively included as subjects.According to the results of thyroid function examination(4~12 weeks of pregnancy),they were divided into OH group(104 cases with TSH>3.6 mIU/L and FT_(4)<11.49 pmol/L)and SCH group(180 cases with TSH>3.6 mIU/L and FT_(4)<11.49~18.84 pmol/L);Another 150 pregnant women with normal thyroid function in the same period were randomly selected as the control group.No matter whether the anti thyroid peroxidase antibody(TPOAb)is positive or not,the OH group and SCH group were treated with levothyroxine L-T_(4)immediately,so as to maintain the L-T_(4) dose after reaching the early pregnancy TSH<2.5 IU/L.The pregnancy outcome at 28 weeks of gestation was compared,and the factors affecting the pregnancy outcome were analyzed.Results The spontaneous abortion rate in OH group after intervention[13.46%(14/104)]was significantly higher than that before intervention[35.58%(37/104)](P<0.001);The spontaneous abortion rate in the SCH group after intervention[10%(18/180)]was significantly higher than that before intervention[34.44%(62/180)](P<0.001);The spontaneous abortion rate in the control group[8%(12/150)]had no significant difference compared with the previous spontaneous abortion rate[(7.33%)(11/150)](P=0.828);After intervention,the spontaneous abortion rates of OH group,SCH group and control group were no significant difference among the three groups(P=0.375);In univariate analysis,among the factors of≤8 weeks screening,TPOAb,age(≥30 years old),previous history of spontaneous abortion,multiple pregnancy history and infertility history,only≤8 weeks screening had statistical significance(P<0.001).Conclusions For pregnant patients with OH and SCH,whether TPOAb is positive or not,L-T_(4)should be used immediately.Screening and treatment before 8weeks of pregnancy may be the time window affecting spo

关 键 词：妊娠 临床甲状腺功能减退 亚临床甲状腺功能减退 左旋甲状腺素钠 自然流产 影响因素 

分 类 号：R714.256[医药卫生—妇产科学] R714.21[医药卫生—临床医学]