妊娠期低甲状腺素血症对妊娠结局及胎儿影响的相关研究
发布时间：2018-01-19 01:22
本文关键词： 回顾性研究 前瞻性研究 低甲状腺素血症 妊娠结局 甲状腺自身抗体 出处：《第二军医大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:1.探讨妊娠期低甲状腺素血症对妊娠结局及胎儿影响,明确激素治疗的可行性及需要补充激素的孕妇特征。2.了解妊娠妇女甲状腺功能状况并建立本单位妊娠期妇女血清甲状腺检测指标特异参考范围。3.探究低甲状腺素血症对妊娠期各检测指标的影响并寻找影响游离甲状腺素(freethyroxine,FT4)水平的因素。明确甲状腺筛查的时机和随访重点,为妊娠期妇女分类指导提供依据。方法:回顾性分析2014年11月~2015年10月我院产科1633例住院孕妇资料,包括妊娠期间及分娩时各项检查、末次超声、新生儿足跟血促甲状腺激素(TSH)值等资料,分组比较相关指标差异。前瞻性收集2016年2月~2017年1月我院产科门诊1596例孕妇建卡资料,建卡时规范甲状腺功能检测,跟踪其中期糖尿病筛查结果、最后一次超声检查结果和生产基本情况。采用2011年美国甲状腺学会(American throid association,ATA)指南标准统计各甲状腺疾病发病情况,并分组进行比较。探讨妊娠期低甲状腺素血症对妊娠期的影响、妊娠结局的不同、胎儿基本情况的差异,分析与低甲状腺素血症相关的因素,明确甲状腺筛查的时机和随访情况。结果:回顾性研究中,在资料完整的1141例孕妇中,既往有甲状腺疾病史者200例,血游离甲状腺素(FT4)低于正常值189例,正常对照组752例。依据血FT4水平低于正常值5%、5%~10%及10%以上,分为A(n=60)、B(n=40)、C(n=89)三组。与正常对照组比较,C组早产、妊娠期糖尿病、剖宫产率明显增高(P0.05),B组孕前高血压和血脂异常率也明显升高(P0.05)。B组、C组剖宫产率明显高于A组,且C组明显高于正常对照组(P0.05)。分娩时C组孕妇年龄、体重、体质指数、舒张压及末次超声胎儿头围均大于正常对照组孕妇(P0.01),但新生儿孕周(38.55±1.86周)小于正常对照组孕妇(39.14±1.57周,P0.01)。除去怀孕时发现甲状腺功能异常及(或)既往有甲状腺疾病史者200例,依据TPOAb水平是否阳性分组,TPOAb阳性组孕妇的糖化血红蛋白水平(8.9±5.89%VS5.36±0.99%)和白蛋白/球蛋白比值(1.86±3.66VS1.43±0.20)明显高于TPOAb阴性组(P0.01)(P0.05),而FT4水平明显低于TPOAb阴性组(P0.05)。前瞻性研究中,得到本院妊娠妇女血清甲状腺功能指标参考值范围:早期妊娠:FT3 3.95-6.76 Pmol/L;FT4 12.38-22.47Pmol/L;TSH 0.01-5.17 m IU/L。中期妊娠:FT33.72-6.05Pmol/L;FT4 11.22-19.01Pmol/L;TSH 0.05-4.87 mIU/L。早期妊娠组建卡宫底高度、FT3、FT4、AST、TC、HbA1c、OGTT空腹血糖水平明显高于中期妊娠组(p0.05)(p0.01)。低FT4组建卡孕周、年龄、体重、BMI、建卡时宫低高度大于正常对照组,TPOAb、WBC、中性粒细胞百分比、TC、TG、LDL-C水平、HbA1c值明显高于正常对照组(p0.05)(p0.01);但身高、舒张压、胎心、血色素、FT3、FT4、淋巴细胞百分率、HGB、红细胞比积、白/球、血葡萄糖水平、肌酐水平明显低于正常对照组(p0.05)(p0.01)。早期妊娠中,G组孕妇年龄明显大于H组(32.71±2.81岁vs 29.51±3.87岁)(p0.05);中期妊娠中,I组建卡孕周明显大于J组,TPOAb、肌酐、尿酸、HbA1c水平高于J组(p0.01)。低FT4组难产率(51.85%vs 41.31%)、胎盘粘连率(2.78%vs0.14%)、人工授精率(9.23%vs 4.90%)均明显高于甲状腺功能正常组(p0.05);但妊娠期糖尿病发生率低于该组(p0.05)。TPOAb(+)孕妇(106名)各甲状腺功能异常情况发生率均高于全体孕前甲状腺功能正常孕妇(1529名),但仅有亚临床甲减有统计学差异(p0.05)。TPOAb(+)组TSH明显高于TPOAb(-)组(p0.05);建卡孕周、ALT、AST水平均低于TPOAb(-)组(p0.05)。早期妊娠建卡孕妇,建卡时甲亢者复查率(100%)复查甲功正常率(60%)均最高;中期妊娠建卡孕妇,建卡时甲减者复查率(76.19%)最高,亚临床甲减复查甲功正常率(15.78%)最高。结论:1、回顾性和前瞻性研究均提示妊娠期HT发病率日渐上升,且无论血TPOAb是否阳性,HT对妊娠结局及胎儿均会造成不同程度的影响。2、高龄及超重可能增加孕妇HT的发生风险,HT可能与孕妇糖调节异常间存在一定的相关性。3、TPOAb阳性可能对FT4、TSH水平及糖代谢异常有一定提示作用。4、建议应重视妊娠早期孕妇的甲功检查,并依据病情制定相应诊疗计划。
[Abstract]:Objective: 1. to investigate gestational hypothyroxinemia effect on the outcome of pregnancy and fetus, pregnant women.2. feasibility of hormone therapy and clear understanding of pregnant women need to supplement the hormone thyroid function status and establish the unit period of serum thyroid specific indexes of women reference range of.3. on pregnancy hypothyroxinemia indexes of pregnancy and to find effect effect of free thyroxine (freethyroxine, FT4) level factors. Clear time and follow-up focus on thyroid screening, provide the basis for the guidance of pregnant women. Methods: a retrospective analysis of the November 2014 ~2015 year in October in our hospital 1633 cases of hospitalized pregnant women during pregnancy and delivery, including the inspection, at the time of ultrasound, neonatal heel serum thyroid stimulating hormone (TSH) value data, comparing the differences of related index. Prospectively collected from February 2016 to January 2017 Gynecology clinic data of 1596 cases of pregnant women Jianka, Jianka standard thyroid function detection, tracking results of screening of diabetes during the last ultrasound examination results and the basic conditions of production. By 2011 the American Thyroid Association (American Throid, association, ATA) for each standard statistical incidence of thyroid disease, and pregnancy were compared. Hypothyroxinemia effect on pregnancy, pregnancy outcome, difference in the basic situation of the fetus, analysis of factors associated with hypothyroxinemia, clear thyroid screening time and follow-up. Results: in the retrospective study, the data of 1141 pregnant women in the complete history of 200 cases of thyroid disease history, blood free thyroxine (FT4) lower than normal in 189 cases, 752 cases of normal control group. On the basis of the blood FT4 level lower than the normal value of 5%, more than 5%~10% and 10%, divided into A (n=60), B (n= 40), C (n=89) three groups. Compared with normal control group, C group, preterm birth, gestational diabetes, the rate of cesarean section increased significantly (P0.05), B group, pre hypertension and dyslipidemia rate was significantly higher (P0.05).B group, C group, the cesarean section rate was significantly higher than A group, and C group was higher than the normal control group (P0.05). C group of childbirth maternal age, body weight, body mass index, diastolic blood pressure and the end time of ultrasonic fetal head circumference were higher than normal pregnant women in the control group (P0.01), but the neonatal gestational age (38.55 + 1.86 weeks) less than normal pregnant women in the control group (39.14 + 1.57 weeks, in addition to P0.01). To find the abnormal thyroid function during pregnancy and (or) 200 cases had a history of thyroid disease, according to the TPOAb level is positive group, HbA1c levels in TPOAb positive group (8.9 + 5.89%VS5.36 + 0.99%) and albumin / globulin ratio (1.86 + 3.66VS1.43 + 0.20) was significantly higher than TPOAb negative group (P0.01) (P0.05), while the level of FT4 TPOAb was significantly lower than the negative group (P0.05). The prospective study, the serum thyroid function of women of pregnancy index reference value range: early pregnancy: FT3 3.95-6.76 Pmol/L; FT4 12.38-22.47Pmol/L; TSH 0.01-5.17 m IU/L. FT4 11.22-19.01Pmol/L mid pregnancy: FT33.72-6.05Pmol/L; TSH; 0.05-4.87 mIU/L. early pregnancy form card fundal height, FT3, FT4. AST, TC, HbA1c, fasting blood glucose level of OGTT was significantly higher than that in mid pregnancy group (P0.05) (P0.01). The formation of low FT4 card gestational age, body weight, BMI, when the house of cards low height is greater than the normal control group, TPOAb, WBC, neutrophil percentage, TC, TG, LDL-C level, HbA1c value significantly higher than the normal control group (P0.05) (P0.01); but the height, diastolic blood pressure, fetal heart rate, hemoglobin, FT3, FT4, HGB, lymphocyte percentage, hematocrit, albumin / globulin, blood glucose level, serum creatinine levels were significantly lower than the normal control group (P0.05) (P0.01). 鏈熷濞犱腑,G缁勫瓡濡囧勾榫勬槑鏄惧ぇ浜嶩缁，
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