双胎妊娠早期甲状腺功能减退及与早产风险的相关分析  

Early hypothyroidism in twin pregnancy and its correlation with the risk of premature birth

作　　者：雷声云 陈蕊[2] 薛芳芳[2] 董晋 Lei Shengyun;Chen Rui;Xue Fangfang;Dong Jin(Xi’an Medical University,Xi’an 710021,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xi’an Medical University,Xi’an 710077,China;Department of Obstetrics,Northwest Women’s and Children’s Hospital,Xi’an 710061,China)

机构地区：[1]西安医学院,西安710021 [2]西安医学院第一附属医院妇产科,西安710077 [3]西北妇女儿童医院产科,西安710061

出　　处：《中华内分泌外科杂志（中英文）》2024年第2期248-251,共4页Chinese Journal of Endocrine Surgery

基　　金：陕西省科学技术厅重点研发计划一般项目(2022SF-553)。

摘　　要：目的探讨双胎妊娠早期甲状腺功能与早产风险的关联性。方法回顾性纳入2021年1月至2022年11月在西北妇女儿童医院产科住院分娩的双胎孕妇186例,其中促甲状腺激素(thyroid stimulating hormone,TSH)值为0.01~3.35 mIU/L的双胎孕妇80例为正常组,TSH>3.35 mIU/L的双胎孕妇106例为甲状腺功能减退组(甲减组)。比较两组甲状腺指标及不良妊娠结局发生率,采用Logistic回归分析甲状腺功能与早产相关性。结果甲减组TSH水平为(4.56±1.18)μIU/L,高于正常组的(1.32±0.69)μIU/L(P<0.05);甲减组有甲减病史、甲状腺自身抗体阳性、使用左旋甲状腺素类药物患者比例为13.21%、34.91%、63.21%,均高于正常组的2.50%、16.25%、3.75%(P<0.05);甲减组FT4水平为(9.03±4.69)pmol/L,低于正常组的(16.48±5.53)pmol/L(P<0.05);甲减组妊娠期糖尿病(gestational diabetes mellitus,GDM)、早产发生率分别为52.83%、50.94%,均高于正常组的32.50%、31.25%(P<0.05)。以妊娠并发症及妊娠结局为因变量,以TSH水平、年龄、绒毛膜性为自变量进行多因素Logistic回归分析,结果显示在对有甲减病史、甲状腺自身抗体阳性、使用左旋甲状腺素类药物等因素的差异进行校正后,甲减是发生GDM(OR=2.135)、早产(OR=1.442)的独立危险因素(P<0.05)。结论双胎妊娠早期出现甲减可明显增加GDM与早产风险。Objective To investigate the association between thyroid function in early twin pregnancy and the risk of preterm birth.Methods One hundred and eighty six twin pregnant women who were hospitalized for delivery at Northwest Women’s and Children’s Hospital from Jan.2021 to Nov.2022 were retrospectively included,and 80 twin pregnant women with TSH values ranging from 0.01 to 3.35 mIU/L were included in the normal group.A total of 106 twin pregnancy women with TSH>3.35 mIU/L were classified as hypothyroidism group(hypothyroidism group).Thyroid indices and incidence of adverse pregnancy outcomes were compared between the two groups,and Logistic regression was used to analyze the correlation between thyroid function and preterm birth.Results TSH level in hypothyroidism group was(4.56±1.18)uIU/L,higher than that in normal group(1.32±0.69)uIU/L(P<0.05).The proportions of patients with hypothyroidism history,positive thyroid autoantibodies and levothyroxine use in hypothyroidism group were 13.21%,34.91%and 63.21%,higher than those in normal group(2.50%,16.25%and 3.75%,P<0.05).FT4 level in hypothyroidism group was(9.03±4.69)pmol/L,lower than that in normal group(16.48±5.53)pmol/L(P<0.05).The incidence rates of gestational diabetes mellitus(GDM)and preterm birth in hypothyroidism group were 52.83%and 50.94%,respectively,higher than 32.50%and 31.25%in normal group(P<0.05).Multiple Logistic regression analysis was performed with pregnancy complication and pregnancy outcome as dependent variables and TSH level,age,chorionic character as independent variable.The results showed that after adjusting for differences in factors such as history of thyroid,thyroid autoimmune antibodies,and use of levothyroxine,hypothyroidism was an independent risk factor for GDM(OR=2.135)and preterm birth(OR=1.442)(P<0.05).Conclusion Hypothyroidism in early twin pregnancy can significantly increase the risk of GDM and preterm birth.

关 键 词：双胎 甲状腺功能 早产 妊娠期糖尿病 妊娠结局 

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