孕晚期不同滴度过氧化物酶抗体与新生儿甲减关系

发布时间：2018-05-01 06:05

本文选题：孕晚期 + 甲状腺过氧化物酶抗体　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过研究甲功正常伴甲状腺过氧化物酶抗体阳性孕妇与其新生儿甲状腺功能的关系,探讨孕晚期不同滴度TPO-Ab对后代甲状腺功能的影响。了解过氧化物酶抗体与甲状腺功能异常的相关性,为妊娠期甲状腺功能筛查的必要性及干预的必要性提供理论依据。方法:选取2015年1月至2016年12月来我院就诊的,除甲状腺疾病外其他孕检项目均正常的孕晚期妊娠妇女及其分娩的新生儿作为研究对象。收集孕妇的流行病资料和甲状腺疾病筛查常用指标资料以及新生儿的健康情况和甲状腺疾病筛查常用指标资料作为分析数据,根据孕妇怀孕28周以后孕晚期初次查出的TPO-Ab滴度水平将所有研究对象分为三组,比较三组研究对象在甲状腺相关指标上的差异性,并采用logistics回归分析影响新生儿甲减的主要危险因素,分析孕妇甲状腺抗体指标与新生儿甲状腺相关指标的相关性。结果:本次研究共收集207名符合研究标准的孕妇,所有孕妇的平均TPO-Ab滴度水平为79.5±16.7IU/mL,根据其TPO-Ab滴度水平分成三组,其中正常组96人,低水平升高组78人,高水平升高组33人,三组孕妇在年龄、孕周和体质指数上均无明显的统计学差异。所有孕妇孕晚期检测的TSH、TG-Ab、FT3和FT4平均值分别为2.2±1.4uIU/mL、50.4±25.0IU/mL、3.1±1.3pmol/L和14.1±2.9pmol/L,三组孕妇在FT3和FT4的水平上无明显的统计学差异,但低水平升高组和高水平升高组孕妇的TSH水平要明显高于正常孕妇(F=9.363,P0.001),高水平升高组孕妇的TG-Ab同样明显高于其他两组(F=159.040,P0.001)。207名孕妇共成功分娩出新生儿213例,新生儿出生后的甲状腺疾病筛查指标中TPO-Ab、TG-Ab、TSH、FT3和FT4的平均滴度水平分别为29.9±15.7IU/mL、24.4±4.5IU/mL、3.7±2.3uIU/mL、3.6±1.6pmol/L和19.8±6.5pmol/L。根据其母亲的分组将新生儿同样归入相应的组别,比较后显示高水平升高组孕妇分娩的新生儿Apgar评分和体重均明显小于其余两组(F=7.236,P=0.001;F=4.646,P=0.011),高水平升高组新生儿的TPO-Ab和TSH水平明显高于对照组和低水平升高组(F=908.543,P0.001;F=100.818,P0.001),FT4明显低于其他两组(F=107.735,P0.001)。本研究中被诊断为甲状腺功能减退症的新生儿有15名,但仅有孕妇的TPO-Ab滴度水平是影响其新生儿甲状腺功能减退的危险因素(OR=1.278,P0.001)。新生儿母亲TPO-Ab的滴度水平与新生儿的TG-Ab和FT3水平之间无明显的相关性,孕妇的TPO-Ab的滴度水平与新生儿的TPO-Ab和TSH存在明显的正相关性(r2=0.793,P0.001;r2=0.597,P0.001)。结论:孕晚期孕妇的TPO-Ab水平是影响新生儿甲状腺功能减退的危险因素,并且孕晚期孕妇TPO-Ab水平与新生儿的TPO-Ab和TSH水平存在明显的正相关性。
[Abstract]:Objective: to study the relationship between thyroid function and thyroid function in pregnant women with thyroid peroxidase antibody positive and normal thyroid function, and to explore the effect of different titers of TPO-Ab on thyroid function of offspring in late pregnancy. To understand the correlation between peroxidase antibody and thyroid dysfunction, and to provide theoretical basis for screening thyroid function during pregnancy and the necessity of intervention. Methods: from January 2015 to December 2016, pregnant women with normal pregnancy and other pregnancy items except thyroid diseases and their newborns were selected as the research objects. Collecting epidemiological data of pregnant women and commonly used indicators for screening thyroid diseases, as well as information on the health status of newborns and common indicators for screening thyroid diseases, as analytical data, All the subjects were divided into three groups according to the TPO-Ab titer detected in the first trimester of pregnancy after 28 weeks of pregnancy, and the differences of thyroid related indexes among the three groups were compared. The main risk factors of neonatal hypothyroidism were analyzed by logistics regression analysis. Results: a total of 207 pregnant women were collected in this study. The average TPO-Ab titer of all pregnant women was 79.5 卤16.7 IUU / mL. According to their TPO-Ab titers, they were divided into three groups: normal group (96 cases), low level group (78 cases) and high level group (33 cases). There was no significant difference in age, gestational age and BMI among the three groups. The mean values of TSH TG-Abn FT3 and FT4 in all pregnant women were 2.2 卤1.4u / mLT = 50.4 卤25.0U / mL and 14.1 卤2.9pmol / L, respectively. There was no significant difference in FT3 and FT4 levels among the three groups. However, the TSH level of the pregnant women in the low and high level groups was significantly higher than that in the normal pregnant women. The TG-Ab of the pregnant women in the high level group was also higher than that in the other two groups. The average titer of TPO-Ab-TG-Ab-TSHFT3 and FT4 were 29.9 卤15.7IUmL, 24.4 卤4.5IUmL, 3.7 卤2.3uIUmL + 3.6 卤1.6pmol/L and 19.8 卤6.5pmol / L, respectively. According to the grouping of their mothers, the newborns are similarly grouped into the corresponding groups, The results showed that the Apgar score and body weight of the newborns in the high level group were significantly lower than those in the other two groups. The levels of TPO-Ab and TSH in the high level group were significantly higher than those in the control group and the low level group. The levels of TPO-Ab and TSH in the high level group were significantly lower than those in the other two groups. In this study, 15 neonates were diagnosed with hypothyroidism, but only the TPO-Ab titer of pregnant women was the risk factor of neonatal hypothyroidism. There was no significant correlation between the titer of TPO-Ab and the levels of TG-Ab and FT3 in newborns. There was a positive correlation between the titer of TPO-Ab in pregnant women and TPO-Ab and TSH in newborns. There was a significant positive correlation between the titer of TPO-Ab and TPO-Ab and TSH in newborns. Conclusion: the level of TPO-Ab is a risk factor for neonatal hypothyroidism, and there is a significant positive correlation between the level of TPO-Ab and the levels of TPO-Ab and TSH of the newborns in the third trimester of pregnancy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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