妊娠期治疗甲状腺功能减退对改善母儿预后的价值

发布时间：2018-06-24 05:23

本文选题：妊娠 + 甲状腺激素　；参考：《复旦大学》2014年博士论文

【摘要】：第一部分妊娠期不同阶段不同试剂的甲状腺功能参考值范围制定目的制定不同试剂不同孕期的血清促甲状腺激素、游离三碘甲腺原氨酸,游离四碘甲腺原氨酸的参考值范围。方法参考值人群选择妊娠妇女样本量至少120例,排除有甲状腺疾病个人史和家族史者,排除可见或可以触及的甲状腺肿,排除服用药物者,排除甲状腺自身抗体阳性者。采用雅培、西门子、罗氏的试剂盒采用直接化学发光技术的竞争免疫测定法检测甲状腺功能。结果雅培早孕期TSH、FT3、FT4参考值为0.04-3.61 mIU/L、3.60-5.81pmol/L、 12.32-21.66pmol/L,中孕期参考值为0.09-3.93 mIU/L、3.70-5.95pmol/L、 11.19-19.14 pmol/L.西门子早孕期TSH、FT3、FT4参考值为0.02-3.24 mIU/L、 3.58-5.41pmol/L、11.85-21.26pmol/L,中孕期参考值为0.09-4.57 mIU/L、 3.30-5.22pmol/L、10.68-17.65pmol/L。罗氏早孕期TSH、FT3、FT4参考值为0.03-4.17mIU/L.3.61-5.87pmol/L、11.57-20.88pmol/L,孕13-19+6周的参考值为0.19-4.94mIU/L、3.36-5.35 pmol/L、10.09-16.88 pmol/L,孕20-27+6周的参考值为0.7-5.42mIU/L、3.00-4.74 pmol/L、8.39-13.79pmol/L,孕28-40周的TSH参考值为0.63-5.52mIU/L、3.02-4.73 pmol/L、8.35-14.14pmol/L。结论TSH参考值上限随妊娠进展而上升。第二部分药物治疗对妊娠期甲状腺自身抗体阴性的亚临床甲减孕妇的母儿短期预后影响目的了解药物治疗妊娠期甲状腺自身抗体阴性的亚临床甲减孕妇是否对母儿短期预后产生影响。方法选择从2011年8月-2013年10月复旦大学附属妇产科医院孕20周内筛查出的甲状腺自身抗体阴性的亚临床甲减单胎孕妇作为研究对象,根据药物治疗情况分为治疗组和未治疗组。研究期内治疗组有184例入组,未治疗组有179例入组。结果未治疗组有4例优生引产、1例自然流产。治疗组无流产和优生引产。两组孕妇妊娠结局如妊娠期糖尿病、妊娠期高血压疾病、胎盘早剥、前置胎盘、胎膜早破、胎窘、早产、低出生体重儿、巨大儿方面的组间差异无统计学意义。结论药物治疗妊娠期自身抗体阴性的亚临床甲减不具有改善母儿短期预后的价值。第三部分妊娠期甲状腺功能减退的孕前干预模式和孕期干预模式对改善母儿预后的干预效果比较目的比较孕前治疗和孕期治疗对改善母儿预后的效果。方法2011年8月-2013年10月共分娩了1019例临床甲减和亚临床甲减孕妇。孕前诊断临床甲减的有168例,孕前诊断亚临床甲减的20例,无失访。孕期筛查发现临床甲减和亚临床甲减的有831例,失访19例。其中孕20周内筛查干预的临床甲减有49例,孕20周内筛查干预的亚临床甲减有303例。截至2014年3月子代6月、1岁评估Gesell量表的共104例、113人次。有71例随访了子代6月龄Gesell量表评分,其中孕前干预组30例,孕期干预组41例。有42例随访了子代1岁Gesell量表评分,其中孕前干预组15例,孕期干预组27例。结果孕前临床甲减干预组未发生自然流产,孕期临床甲减干预组有2例自然流产,两组自然流产比例差异有统计学意义。孕期临床甲减甲减及时干预后,妊娠期糖尿病、妊娠期高血压疾病、胎盘早剥、早产、低出生体重的并发症与孕前干预组之间的差异无统计学意义。孕前干预组和孕期干预组子代6月龄、12月龄的Gesell量表各功能区评分(粗动作能、细动作能、应物能、言语能、应人能)方面的差异均无统计学意义,各功能区评分低于85分的比例差异无统计学意义。结论孕前干预临床甲减可降低自然流产风险。孕前干预甲减和亚甲减在改善子代脑发育方面并不优于孕16周前干预。
[Abstract]:The range of reference value of thyroid function of different reagents at different stages of pregnancy was set up to formulate the reference range of serum thyrotropin, free three iodide adenosine and free four iodosine adenosine. Method reference value crowd selected at least 120 cases of pregnant women, excluding the form of thyroid gland. The individuals of the individual and family history of adenoid disease exclude the visible or accessible goiter, exclude the drug users and exclude the thyroid autoantibody positive. The use of Abbott, SIEMENS, and Roche's kit used the competitive immunoassay of direct chemiluminescence to detect thyroid gland function by the direct chemiluminescence assay. Results the reference value of TSH, FT3, FT4 in Abbott was 0. 04-3.61 mIU/L, 3.60-5.81pmol/L, 12.32-21.66pmol/L, 0.09-3.93 mIU/L, 3.70-5.95pmol/L, 11.19-19.14 pmol/L. SIEMENS early pregnancy TSH, FT3, FT4 reference value The reference value of TSH, FT3, FT4 is 0.03-4.17mIU/L.3.61-5.87pmol/L, 11.57-20.88pmol/L, the reference value of the gestational 13-19+6 week is 0.19-4.94mIU/L, 3.36-5.35 pmol/L, 10.09-16.88 pmol/L. 14pmol/L. conclusion the upper limit of TSH reference value increases with the progression of pregnancy. The effect of the second part of the drug treatment on the short-term prognosis of the mothers and children of subclinical hypothyroidism pregnant women with negative thyroid autoantibodies in pregnancy The subclinical subclinical hypothyroidism, which was screened from the 20 weeks of pregnancy in the obstetrics and Gynecology Hospital Affiliated to Fudan University, August 2011, in October -2013, was selected as the study object, and divided into the treatment group and the untreated group according to the drug treatment. In the study period, there were 184 cases in the treatment group and 179 cases in the untreated group. The results were not. In the treatment group, 4 cases were induced by eugenics and 1 cases of spontaneous abortion. There was no abortion and eugenics in the treatment group. The pregnancy outcome in two groups of pregnant women, such as gestational diabetes, pregnancy induced hypertension, placental abruption, placenta previa, premature rupture of fetal membrane, fetal distress, premature birth, low birth weight, no statistically significant difference between the groups. The value of subclinical hypothyroidism with negative autoantibodies does not have the value of improving the short-term prognosis of the mother and children. Third comparison of pre pregnancy intervention and intervention mode of pregnancy during pregnancy and pregnancy intervention to improve the prognosis of mothers and children comparison of the effect of pre pregnancy treatment and pregnancy treatment on the improvement of mother and child prognosis. Method August 2011 -2013 In October, 1019 cases of clinical hypothyroidism and subclinical hypothyroidism were delivered. There were 168 cases of clinical hypothyroidism diagnosed before pregnancy and 20 cases of subclinical hypothyroidism before pregnancy. 831 cases of clinical hypothyroidism and subclinical hypothyroidism were found during pregnancy screening, and 19 cases were lost. Among them, 49 cases of clinical hypothyroidism in 20 weeks of pregnancy and screening intervention within 20 weeks of pregnancy Subclinical hypothyroidism had 303 cases. Up to the 3 month of 2014, 104 cases of Gesell scale were assessed at 1 years old in June. 71 cases were followed up on the progeny 6 month old Gesell scale score, including 30 prepregnancy intervention group and 41 pregnant intervention group. 42 cases were followed up by the subgeneration 1 year Gesell scale score, and the pregnancy intervention group 15 cases, pregnancy intervention group 27 cases. There were no spontaneous abortion in the pre clinical hypothyroidism intervention group and 2 cases of spontaneous abortion in the clinical hypothyroidism intervention group during pregnancy, and the difference in the proportion of spontaneous abortion in the two groups was statistically significant. There was no significant difference in the difference between the pre pregnancy intervention group and the pregnancy intervention group and the 6 month old, 12 month old Gesell scales of the subgeneration of the children. There was no statistically significant difference in the scores of the functional areas (coarse action energy, fine movement energy, stress, speech energy, human ability), and there was no significant difference in the proportion of the functional area score below 85. Hypothyroidism can reduce the risk of spontaneous abortion. Prenatal intervention hypothyroidism and hypothyroidism are not superior to the intervention of 16 weeks before pregnancy in improving offspring brain development.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R714.256

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