妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析

发布时间：2018-03-08 07:22

本文选题：回顾性研究　切入点：低甲状腺素血症　出处：《解放军医学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨妊娠期低甲状腺素血症对妊娠结局及胎儿的影响,明确激素治疗的可行性。方法回顾性分析2014年11月-2015年10月第二军医大学附属长海医院收治的1141例孕妇资料,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,并比较不同程度低甲状腺素血症孕妇相关指标间的差异。结果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[依据血FT4水平低于正常值0~5%、5%~10%及10%以上,分为A(n=60)、B(n=40)、C(n=89)三组],正常对照组752例。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)。其中,B、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组孕妇体重、体重指数、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)。189例低甲状腺素血症孕妇依据甲状腺过氧化物酶抗体(TPOAb)浓度分组后发现抗体阳性组胎儿末次超声头围明显大于阴性组(45.99±62.36 vs 33.23±2.08cm,P0.01)。结论不同程度的低FT4血症均会对妊娠结局及胎儿造成影响,尤其是血FT4值低于正常值10%以上或TPOAb阳性时。建议孕妇在孕早期行甲状腺功能检测。
[Abstract]:Objective to investigate the effect of hypothyroidism during pregnancy on pregnancy outcome and fetus and to determine the feasibility of hormone therapy. Methods the data of 1 141 pregnant women admitted to Changhai Hospital affiliated to the second military Medical University from November 2014 to October 2015 were retrospectively analyzed. The data included various examinations during pregnancy and delivery, final ultrasound, TSHs of calcaneal blood of newborns, and the differences of relative indexes among pregnant women with different degrees of hypothyroidism. Results among 1141 pregnant women, There were 200 cases with a history of thyroid disease and 189 cases with serum free thyroxine FT _ 4 below the normal value [10% and more than 10% of the blood FT4 levels were divided into three groups: group A, n = 60, B, n = 40, C, n = 89] and the control group, in which there were 752 cases of preterm delivery in group C, compared with the normal control group. In gestational diabetes mellitus, the rate of cesarean section was significantly higher than that in group B (P 0.05). The rate of cesarean section in group C was significantly higher than that in group A, and the rate of cesarean section in group C was significantly higher than that in group A. the body weight and body mass index (BMI) of pregnant women in group C were significantly higher than those in group C at delivery. Diastolic blood pressure and fetal head circumference of the last ultrasound were higher than that of normal pregnant women, but the gestational weeks of newborns were 38.55 卤1.86 weeks), which were lower than that of normal pregnant women (39.14 卤1.57 weeks). 189 cases of hypothyroidism pregnant women with hypothyroidism were based on the TPOAbconcentration score of thyroid peroxidase antibody. It was found that the fetal head circumference of the last ultrasound in the positive group was significantly larger than that in the negative group (45.99 卤62.36 vs 33.23 卤2.08 cm ~ (-1) P 0.01). Conclusion different degrees of hypothyroidism may affect the outcome of pregnancy and the fetus. Especially when the serum FT4 value is below the normal value of 10% or TPOAb positive, it is suggested that pregnant women should be tested for thyroid function in early pregnancy.
【作者单位】：第二军医大学附属长海医院内分泌科;第二军医大学附属长海医院妇产科;
【基金】：国家自然科学基金(81471038) 国家卫生和计划生育委员会专项基金(201502011)~~
【分类号】：R714.256

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