妊娠中晚期亚临床甲状腺功能减退症对母亲及胎儿合并症的影响

发布时间：2018-01-16 12:04

  本文关键词：妊娠中晚期亚临床甲状腺功能减退症对母亲及胎儿合并症的影响　出处：《湖南师范大学》2013年硕士论文　论文类型：学位论文

  更多相关文章： 妊娠中晚期 亚临床甲状腺功能减退症 甲状腺过氧化物酶抗体 妊娠结局

【摘要】：目的：探讨2012年中华医学会《妊娠和产后甲状腺疾病诊治指南》和2011年美国甲状腺学会(American Thyroid Association, ATA)《妊娠和产后甲状腺疾病诊治指南》诊断妊娠中晚期亚临床甲减临床应用的合理性及妊娠中晚期亚临床甲减对母亲及胎儿合并症的影响。 方法：收集了2011年8月至2013年2月在湖南省人民医院产科病房住院分娩且在妊娠中期或者晚期检测了甲状腺功能、资料完整的491名孕妇的病历资料。 1.采用2012年中华医学会《妊娠和产后甲状腺疾病诊治指南》推荐的Roche试剂妊娠中晚期TSH、FT4参考值分组：亚临床甲减组(n=9),低T4血症组(n=46),正常对照组(n=396)； 2.采用2011年ATA《妊娠和产后甲状腺疾病诊治指南》推荐的妊娠中晚期TSH参考值上限3. OmIU/L分组：亚临床甲减组(n=91,TPOAb阳性8例,TPOAb阴性83例),低T4血症组(n=37, TPOAb阳性7例,TPOAb阴性30例),正常对照组(n=314, TPOAb阳性即单纯TPOAb阳性30例,TPOAb阴性284例),其中血清0.1mIU/LTSH3.0mlU/L、FT4水平正常且TPOAb阴性组孕妇按照TSH水平进行四分位数分组,P1组(n=70):0.19mIU/LTSH≤1.10mIU/L; P2组(n=72):1.10mIU/L TSH≤1.74mIU/L; P3组(n=72):1.74mIU/LTSH≤2.22mIU/L;P4组(n=70):2.22mIU/LTSH≤2.99mIU/L。 分析亚临床甲减、低T4血症、TPOAb阳性与母亲及胎儿合并症,与母亲空腹血糖、血压、体重等指标的关系。 结果： 1.采用2012年中华医学会《妊娠和产后甲状腺疾病诊治指南》推荐的Roche试剂妊娠中晚期TSH、FT4参考值分组： 与正常对照组比较,低T4血症组BMI较大,差异有统计学意义(P0.05)。 2.采用2011年ATA《妊娠和产后甲状腺疾病诊治指南》推荐的妊娠中晚期TSH参考值上限3.OmlU/L分组： 2.1与正常对照组比较,亚临床甲减组胎头下降停滞、胎儿窘迫、新生儿窒息和总胎儿合并症发生率较高,差异有统计学意义(P0.05)。 2.2与正常对照组比较,低T4血症组BMI较大,差异有统计学意义(P0.05)。 2.3与采用中华医学会标准比较,采用2011年ATA标准亚临床甲减的阳性诊断率较高,亚临床甲减组内胎儿窘迫、新生儿窒息、母亲合并症和胎儿合并症的构成比更高,差异有统计学意义(P0.05)。 2.4与抗体阴性亚临床甲减组比较,抗体阳性亚临床甲减组胎儿窘迫的发生率较高,差异有统计学意义(P0.05)。 2.5与抗体阴性低T4血症组比较,抗体阳性低T4血症组胎头下降停滞的发生率较高,差异有统计学意义(P0.05)。 2.6与抗体阴性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常组比较,抗体阴性亚临床甲减组胎儿窘迫的发生率较高,差异有统计学意义(P0.05)。 2.7与抗体阴性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常组比较,抗体阴性低T4血症组BM工较大,收缩压较高,差异有统计学意义(P0.05)。 2.8将抗体阴性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常组(n=284)按照TSH水平四分位分组为P1、P2、P3、P4组。上四分位组(P4组)较下四分位组(P1组)胎儿窘迫发生率增高,差异有统计学意义(P0.01)。 结论： 1.妊娠中晚期亚临床甲减诊断标准中TSH下限采用2011年ATA《妊娠和产后甲状腺疾病诊治指南》推荐的3.OmIU/L能提高亚临床甲减的诊断率,减少漏诊,可能更合理。 2.妊娠中晚期亚临床甲减是妊娠的高危因素,可导致胎儿窘迫、胎头下降停滞、新生儿窒息、总的胎儿合并症发生风险增加。 3.妊娠中晚期TPOAb阳性是妊娠的高危因素,TPOAb阳性合并亚临床甲减或低T4血症可能导致胎儿合并症的发生风险进一步增加。
[Abstract]:Objective: To explore the Chinese Medical Association in 2012 and the "guidelines for diagnosis and treatment of pregnancy: postpartum thyroid disease and 2011 American Thyroid Association (American Thyroid Association, ATA) < influence pregnancy and guidelines for diagnosis and management of postpartum thyroid disease diagnosis of clinical application on advanced subclinical hypothyroidism in pregnancy and in late pregnancy subclinical hypothyroidism on maternal and fetal complications.
Methods: a total of 491 pregnant women who were hospitalized in the maternity ward of Hunan People's Hospital from August 2011 to February 2013 were collected and their thyroid function was examined in the second or third trimester.
1., we used the Roche reagent recommended by the Chinese Medical Association 2012 "guidelines for diagnosis and treatment of thyroid disorders after pregnancy and postpartum". The TSH value of pregnancy was FT4 and the reference values of FT4 were: subclinical hypothyroidism group (n=9), low T4 group (n=46), normal control group (n=396).
By late 2011 2. ATA< pregnancy and postpartum guidelines for diagnosis and management of thyroid disease in pregnancy TSH > recommended limit 3. OmIU/L reference value: group subclinicalhypothyroidism group (n=91, 8 cases were TPOAb positive, 83 TPOAb negative cases), low T4 level group (n=37, 7 cases were TPOAb positive, 30 TPOAb negative cases), normal control group (n=314, TPOAb positive only 30 TPOAb positive cases, 284 cases were TPOAb negative), the serum 0.1mIU/LTSH3.0mlU/L, FT4 levels in normal and TPOAb negative pregnant women were grouped according to the four percentile of the level of TSH, P1 group (n=70): 0.19mIU/LTSH = 1.10mIU/L; P2 group (n=72): 1.10mIU/L TSH group (n=72 = 1.74mIU/L; P3): 1.74mIU/LTSH = 2.22mIU/L; P4 group (n=70): 2.22mIU/LTSH = 2.99mIU/L.
The relationship between subclinical hypothyroidism, hypothyroidism, TPOAb positive and maternal and fetal complications, and maternal fasting blood glucose, blood pressure, weight and other indexes were analyzed.
Result锛，

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