血清TPO-Ab、TG-Ab和TR-Ab在亚临床甲状腺功能减退合并妊娠期高血压中预测妊娠结局的临床价值  

The clinical value of serum TPO Ab,TG Ab,and TR Ab in predicting pregnancy outcomes in subclinical hypothyroidism with gestational hypertension

作　　者：周满红 王艳霞 贺译平 邢燕妮 张弯弯 刘丹 Zhou Manhong;Wang Yanxia;He Yiping;Xing Yanni;Zhang Wanwan;Liu Dan(Department of Obstetrics and Gynecology,Northwest Women's and Children's Hospital,Shaanxi Province,Xi'an 710061,China;不详)

机构地区：[1]西安西北妇女儿童医院妇产科,710061 [2]西安西北妇女儿童医院产二科,710061

出　　处：《疑难病杂志》2024年第2期222-227,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省重点研发计划项目(2023-YBSF-519)。

摘　　要：目的分析亚临床甲状腺功能减退(亚甲减)合并妊娠期高血压(妊高症)患者血清中甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)和促甲状腺激素受体抗体(TR-Ab)表达水平以及对妊娠结局的临床预测价值。方法选取2020年8月—2023年3月在西安西北妇女儿童医院建立生育档案、产检并生产的妊娠期亚甲减孕妇242例,根据是否合并妊高症可分为妊娠亚甲减组68例和亚甲减合并妊高组174例,另选取同时期正常妊娠孕妇242例作为正常妊娠组;采用电化学发光免疫分析法检测血清TPO-Ab、TG-Ab和TR-Ab表达水平;多因素Logistic回归分析妊娠期亚甲减合并高血压患者不良妊娠结局的影响因素;受试者工作特征(ROC)曲线分析血清TPO-Ab、TG-Ab和TR-Ab表达水平对亚甲减合并妊高症患者妊娠结局的预测价值。结果正常妊娠组、妊娠亚甲减组、亚甲减合并妊高组血清TPO-Ab、TG-Ab和TR-Ab表达水平依次显著升高(F/P=85.036/<0.001、26.675/<0.001、23.086/<0.001);正常妊娠组、妊娠亚甲减组、亚甲减合并妊高组促甲状腺激素(TSH)依次升高(F/P=85.052/<0.001);与良好妊娠结局患者比较,不良妊娠结局患者收缩压、舒张压、TSH、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、TPO-Ab、TG-Ab和TR-Ab表达水平显著升高,高密度脂蛋白胆固醇(HDL-C)显著降低,差异均有统计学意义(t/P=3.852/<0.001、2.421/0.017、2.244/0.026、2.342/0.020、2.835/0.005、2.707/0.007、3.475/0.001、3.399/0.001、2.636/0.009、4.280/<0.001);收缩压、舒张压、TPO-Ab、TG-Ab、TR-Ab、TC和LDL-C升高是妊娠期亚甲减合并高血压患者不良妊娠结局的危险因素[OR(95%CI)=3.819(1.376~10.603)、3.235(1.198~8.739)、5.917(2.341~14.953)、9.043(2.924~27.965)、1.768(1.252~2.496)、2.534(1.085~5.921)、4.010(1.559~10.314)];血清TPO-Ab、TG-Ab和TR-Ab及三者联合预测妊娠期亚甲减合并高血压患者妊娠结局的AUC分别为0.723、0.Objective To analyze the expression levels of thyroid peroxidase antibody(TPO Ab),thyroglobulin antibody(TG Ab),and thyroid stimulating hormone receptor antibody(TR Ab)in the serum of patients with subclinical hypothyroidism(hypothyroidism)combined with gestational hypertension(preeclampsia),and their clinical predictive value for pregnancy outcomes.Methods Two hundred and forty-two pregnant women with gestational hypothyroidism who established fertility records,underwent prenatal examinations,and gave birth at the Northwest Women and Children's Hospital in Xi'an from August 2020 to March 2023 were selected.They were divided into 68 cases of gestational hypothyroidism group and 174 cases of hypothyroidism combined with gestational hypertension group based on whether they were complicated with gestational hypertension.Additionally,242 normal pregnant women of the same period were selected as the normal pregnancy group;Using electrochemiluminescence immunoassay to detect the expression levels of serum TPO Ab,TG Ab,and TR Ab;Multivariate logistic regression analysis of the influencing factors of adverse pregnancy outcomes in patients with gestational hypothyroidism combined with hypertension;The predictive value of receiver operating characteristic(ROC)curve analysis of serum TPO Ab,TG Ab,and TR Ab expression levels on pregnancy outcomes in patients with hypothyroidism combined with preeclampsia.Results The expression levels of serum TPO Ab,TG Ab,and TR Ab increased sequentially in the normal pregnancy group,gestational hypothyroidism group,and hypothyroidism combined with preeclampsia group(F/P=85.036/<0.001,26.675/<0.001,23.086/<0.001).The levels of thyroid stimulating hormone(TSH)in the normal pregnancy group,pregnant hypothyroidism group,and hypothyroidism combined with preeclampsia group increased sequentially(F/P=85.052/<0.001).Compared with patients with good pregnancy outcomes,patients with poor pregnancy outcomes showed significantly higher levels of systolic blood pressure,diastolic blood pressure,TSH,tota

关 键 词：亚临床甲状腺功能减退 妊娠期高血压 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 促甲状腺激素受体抗体 

分 类 号：R581.2[医药卫生—内分泌] R714.256[医药卫生—内科学]