妊娠期甲状腺功能正常参考值范围的建立以及妊娠中期甲状腺疾病的流行病学调查

发布时间：2018-06-29 03:18

本文选题：妊娠期 + 甲状腺功能　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的：建立本地区妊娠期甲状腺功能正常参考值范围，探讨本地区妊娠中期甲状腺疾病的发病率，新生儿甲状腺功能状态分析。方法：研究对象均来上海交通大学医学院附属国际和平妇幼保健院产科门诊。第一部分：采集2011年2月17日至6月9日就诊于上海交通大学医学院附属国际和平妇幼保健院的正常孕妇血清样本共693例．按孕周不同分妊娠9～13、16～20、24～28、32～34和37～40周共5组。同期采用2种检测试剂——雅培试剂(Abbott Architect I2000)和罗氏试剂(Roche CobasElecsys600)进行TSH和FT4的检测。根据美国临床牛化研究院建议的甲状腺功能检测指标参考范围的制定方法，将测定结果的第2.5～97.5百分位数作为各项指标的参考范围。第二部分：回顾性分析2010年3月1日-2010年7月31日在上海交通大学医学院附属国际和平妇幼保健院门诊首次建卡登记孕妇资料1889例，，通过问卷调查方法收集所有孕妇的背景资料,将孕妇分为高危组与低危组，孕13～28周检测促甲状腺激素(thyroid-stimulating hormone，TSH)、血清游离甲状腺素(freethyroxine，FT4)，应用妊娠中期特异性甲状腺功能正常参考范围,分别对高危人群及低危人群进行妊娠中期甲状腺功能异常患病率检测，随访至分娩并对新生儿足跟血TSH进行跟踪。结果：妊娠期间，两种检测试剂盒测定的TSH值具有很好的线性相关性且变化趋势一致，均在孕9-13周显著低于其它妊娠时点（P0.01），而在产前（孕37-40周）显著高于其它妊娠时点（P0.01）；Roche试剂测得的各妊娠时点的TSH水平及参考范围均显著高于Abbott试剂（P0.001）。两种检测试剂测定的孕9-13周血清FT4水平均显著高于其它妊娠时点（P0.01）；Roche试剂测得的孕9-13周血清FT4水平显著高于Abbott试剂，而其测得的孕24-28周和产前血清FT4数值显著低于Abbott试剂（均P0.01）。无论是Abbott还是Roche的检测试剂，血清TSH与FT4之间具有统计学意义的相关性仅出现于孕9-13周(雅培试剂：r=-0.319；罗氏试剂r=-0.352，P均0.001）。高危人群占所研究人群的10.69%；如采用高危人群筛查策略，妊娠合并亚临床甲亢将漏诊87.5%（漏诊14例）；妊娠期亚临床甲减将漏诊83.93%（漏诊47例）；低甲状腺素血症将漏诊89.47%（漏诊17例）；单纯甲状腺自身抗体阳性将漏诊88.35%（漏诊91例）；高危人群中甲状腺功能异常的检出率与低危组相比，其差异无统计学意义。在1889例妊娠中期孕妇中检出亚临床甲减患者56例，检出率为2.96%（56/1889）；低T4血症患者19例，检出率为1.01%（19/1889）。亚临床甲减组和低T4血症组孕妇在贫血、胎窘、妊娠期高血压疾病等并发症发病率上与甲状腺功能正常组比较无明显差异。亚临床甲减组及低T4血症组新生儿足跟血TSH水平与甲状腺功能正常组相比，其差异具无统计学意义（χ2=0.552；P=0.7590.05）。结论：血清TSH最能准确反映甲状腺功能，美国甲状腺学会推荐的经验性妊娠期TSH参考范围上限不宜在国内直接采纳，不同检测试剂盒应建立各自的妊娠期甲状腺功能参考范围。对于妊娠中期孕妇进行普遍筛查能够降低妊娠中期甲状腺功能异常的漏诊率。我们推荐在妊娠中期对甲状腺功能进行普遍筛查。亚临床甲减及低T4血症孕妇在妊娠合并贫血、胎窘、妊娠期高血压疾病发生率上与正常孕妇相比差异无显著性；妊娠合并亚临床甲减对新生儿甲状腺功能无明显不利影响。
[Abstract]:Objective: to establish the range of normal reference value of thyroid function during pregnancy, to explore the incidence of thyroid disease in the mid-term pregnancy, and to analyze the thyroid function status of the newborn.
Methods: the subjects were all taken to the Department of Obstetrics and Gynecology of the affiliated International Peace Maternity and child health care hospital of Shanghai Jiaotong University School of Medicine. Part 1: 693 cases of normal pregnant women from February 17, 2011 to June 9th were collected from the affiliated International Peace Maternity and child health care hospital of Shanghai Jiaotong University School of Medicine. According to the different pregnancy weeks, the pregnancy was divided into 9 ~ 13,16 ~ 13,16 There were 5 groups in 28,32 to 34 and 37~40 weeks. 2 testing reagents (Abbott Architect I2000) and Roche reagent (Roche CobasElecsys600) were used to detect TSH and FT4 in the same period. According to the method of formulating the reference frame of the thyroid function test index proposed by the American Institute of clinical bovine research, the results were determined from 2.5 to 9 thousand and 750. The second part: the second part: a retrospective analysis of 1889 cases of the first registration of pregnant women in the outpatient clinic of the International Peace Maternity and child health care hospital affiliated to Shanghai Jiaotong University School of Medicine in July 31st March 1, 2010. The background data of all pregnant women were collected by questionnaire, and the pregnant women were divided into high risk groups and the pregnant women were divided into high risk groups. In the low risk group, the thyroid hormone (thyroid-stimulating hormone, TSH), serum free thyroxine (freethyroxine, FT4) were detected at 13~28 weeks of pregnancy, and the normal range of normal thyroid function was used in the middle pregnancy. The TSH of the heel blood of the newborn was tracked.
Results: during pregnancy, the TSH value of the two detection kits had a good linear correlation and a consistent change trend, which was significantly lower than other pregnancy time points (P0.01) at 9-13 weeks of pregnancy (37-40 weeks of pregnancy) and significantly higher than other pregnancy time points (P0.01), and the TSH level and reference range of each pregnancy point measured by Roche test agent were both significant. The level of serum FT4 was higher than that of the Abbott reagent (P0.001). The level of serum FT4 in the 9-13 weeks of pregnancy measured by two kinds of test reagents was significantly higher than that of other pregnancy time points (P0.01), and the serum FT4 level of 9-13 weeks of pregnancy measured by Roche reagent was significantly higher than that of Abbott reagent, and the serum FT4 value measured by the reagent was significantly lower than that of Abbott reagent (P0.01). It was a test reagent for Roche. The correlation between serum TSH and FT4 was statistically significant only at 9-13 weeks of pregnancy (Abbott reagent: r=-0.319; Roche reagent r=-0.352, P 0.001).
High risk population accounted for 10.69% of the study population; if the high-risk group screening strategy, pregnancy combined with subclinical hyperthyroidism will leak 87.5% (14 cases); subclinical hypothyroidism in pregnancy will be 83.93% (47 cases); hypothyroidemia will leak diagnosis of 89.47% (17 cases); simple thyroid autoantibody positive 88.35% (91 missed diagnosis) There was no significant difference in the detection rate of thyroid dysfunction between high-risk group and low risk group.
In 1889 midtrimester pregnant women, 56 cases of subclinical hypothyroidism were detected, the detection rate was 2.96% (56/1889), and 19 cases with low T4 were 1.01% (19/1889). The incidence of complications such as anemia, fetal distress and pregnancy induced hypertension in subclinical hypothyroidism and hypothyroidism group was not significantly different from that of normal thyroid function group. The difference in the TSH level of heel blood of the subclinical hypothyroidism group and the hypothyroidemia group was not statistically significant compared with the normal thyroid function group (x 2=0.552, P=0.7590.05).
Conclusion: serum TSH is the most accurate reflection of thyroid function. The upper limit of TSH reference range of empirical pregnancy recommended by the American Thyroid Association should not be adopted directly in China. Different detection kits should establish their respective reference range of thyroid function during pregnancy. We recommend a universal screening of thyroid function in the middle of pregnancy. There is no significant difference in the incidence of pregnancy associated anemia, fetal distress, and pregnancy induced hypertension in pregnant women with subclinical hypothyroidism and hypothyroidism than in normal pregnant women; pregnancy combined subclinical hypothyroidism has no obvious thyroid function in newborns. Adverse effects.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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