妊娠合并低T4血症对孕妇及新生儿的影响
发布时间：2018-08-02 14:42
【摘要】：目的通过检测孕妇中晚孕期的血清促甲状腺激素(TSH)、游离甲状腺素(FT4)水平,探讨孕妇低T4血症的发生率及对孕妇及新生儿的不良影响,为及时发现和治疗妊娠合并低T4血症妇女提供依据。 研究对象回顾性分析了2013年1月至2013年10在广西医科大学一附院产科门诊定期产检并住院分娩的141例妊娠合并低T4血症的孕妇及其新生儿的临床资料作为研究组(其中治疗组72例,未治疗组69例),同期随机选取58例在我院定期产检并分娩的无甲状腺功能异常并且无其他合并症的孕妇作为对照组。 研究方法通过测定治疗组、未治疗组及正常组孕妇中、晚孕期的游离甲状腺素(FT4)、促甲状腺激素(TSH)水平；进一步了解孕妇妊娠中期、晚期甲状腺功能水平的变化(或差异);统计各组孕妇发生并发症及妊娠不良结局的发生率；比较各组新生儿出生一般情况及出生72小时后的血清游离甲状腺素(FT4)与促甲状腺激素(TSH)水平。 结果①妊娠期血清TSH、FT4的变化：中孕期：治疗组与未治疗组TSH的均值均高于正常组,差异有统计学意义(P0.05)。晚孕期：未治疗组TSH显著高于治疗组与正常组的TSH,差异有统计学意义(P0.05)；而治疗组与正常对照组相比差异无统计学意义(P0.05)。中、晚孕期：治疗组、未治疗组的FT4的均值低于正常组的FT4,差异有统计学意义(P0.05)；而妊娠晚期治疗组与未治疗组的FT4相比较,差异有统计学意义(P0.05)。②未治疗组的孕妇在晚孕期发展为甲减的发生率显著高于治疗组及正常组的孕妇,差异有统计学意义(P0.05)。未治疗组的孕妇妊娠期糖尿病的患病率显著高于治疗组及正常组,差异有统计学意义(P0.05)。治疗组及未治疗组孕妇的妊娠期高血压疾病患病率明显高于正常组,差异有统计学意义(P0.05)。③治疗组及未治疗组的孕妇分娩的新生儿体重2500g比例明显高于正常组比例,差异有统计学意义(P0.05)。而比较治疗组、未治疗组及正常组孕妇分娩的新生儿的体重、一分钟Apgar评分秩均值及早产率,差异无统计学意义(P0.05)。④未治疗组孕妇的新生儿甲减患病率显著高于治疗组及正常组孕妇的新生儿甲减患病率,差异有统计学意义(P0.05)。治疗组与未治疗组孕妇的新生儿的血清TSH水平显著高于正常组孕妇新生儿的TSH水平,差异有统计学意义(P0.05)；但治疗组与未治疗组孕妇的新生儿血清TSH水平差异无统计学意义(P0.05)。比较治疗组、未治疗组及正常组孕妇的新生儿的血清FT4水平,差异无统计学意义(P0.05)。 结论①妊娠合并低T4血症的孕妇经过治疗后TSH水平明显降低,与正常孕妇晚孕期TSH水平无差异,表明治疗是有效的。②妊娠合并低T4血症与妊娠期糖尿病、新生儿低出生体重等妊娠不良结局相关,孕期检测并调整FT4水平有重要意义或孕期检测甲功并及时治疗低T4血症有重要意义。③未治疗的低T4血症孕妇的新生儿甲减患病率明显高于治疗组及正常组孕妇的新生儿甲减患病率。④妊娠合并低T4血症孕妇的新生儿的血清TSH水平明显高于正常组孕妇的新生儿的血清TSH水平。⑤孕妇妊娠期低T4血症的发病率较高,且进展为临床甲减及亚临床甲减的几率高,孕期开展甲状腺功能筛查并监测甲状腺功能及时发现、治疗甲状腺疾病,对减少孕妇妊娠期合并症、并发症及孕妇和新生儿的不良结局的发生有重要意义。
[Abstract]:Objective to investigate the incidence of hypothyroidemia in pregnant women and the adverse effects on pregnant women and newborns by detecting the level of serum thyrotropin (TSH) and free thyroxine (FT4) during the middle and late pregnancy of pregnant women, and to provide the basis for the timely discovery and treatment of women with hypothyroidemia in pregnancy.
The objective of the study was to review the clinical data of 141 pregnant women and their neonates in the obstetrics outpatient department of Guangxi Medical University from January 2013 to 2013 as the study group (72 cases in the treatment group and 69 cases in the untreated group). 58 cases were randomly selected and divided in our hospital during the same period. 10 cases were randomly selected and divided in our hospital. The pregnant women without thyroid dysfunction and without other complications were used as control group.
The study method was used to determine the level of free thyroxine (FT4) and thyroid stimulating hormone (TSH) in the late pregnancy, in the treatment group, the untreated group and the normal group, and to further understand the changes in the middle trimester of pregnancy and the advanced thyroid function (or difference); the incidence of complications and adverse outcomes of pregnant women in each group were compared. The general situation of newborn birth and serum free thyroxine (FT4) and thyroid stimulating hormone (TSH) level 72 hours after birth.
Results (1) the changes in serum TSH and FT4 during pregnancy: mid pregnancy: the mean value of TSH in the treatment group and the untreated group was higher than that in the normal group, the difference was statistically significant (P0.05). The TSH in the untreated group was significantly higher than the TSH in the treatment group and the normal group (P0.05), but there was no statistical difference between the treatment group and the normal control group. Significance (P0.05), middle and late pregnancy: the mean value of FT4 in the treatment group was lower than that of the normal group FT4, the difference was statistically significant (P0.05), but the difference was statistically significant (P0.05) compared with those in the untreated group (P0.05). (2) the incidence of hypothyroidism in pregnant women in the untreated group was significantly higher than that of the treatment group. The difference between the pregnant women in the normal group was statistically significant (P0.05). The prevalence rate of gestational diabetes in the untreated group was significantly higher than that in the treatment group and the normal group. The difference was statistically significant (P0.05). The prevalence rate of pregnancy induced hypertension in the treatment group and the untreated group was significantly higher than that in the normal group (P0.05). The proportion of birth weight 2500g of pregnant women in the group and untreated group was significantly higher than that of the normal group, and the difference was statistically significant (P0.05). But in the comparison group, the weight of the newborn babies born in the untreated group and the normal group were not statistically significant (P0.05). (P0.05). (4) the pregnant women in the untreated group had no statistical significance (P0.05). The incidence of hypothyroidism in newborn infants was significantly higher than that in the treatment group and the normal group. The difference was statistically significant (P0.05). The serum TSH level of the newborns in the treatment group and the untreated group was significantly higher than that of the normal group, and the difference was statistically significant (P0.05), but the treatment group and the untreated group were pregnant women. There was no significant difference in the level of serum TSH in newborn infants (P0.05). Compared with the treatment group, there was no significant difference in serum FT4 level between the untreated group and the normal group (P0.05).
Conclusions (1) the level of TSH in pregnant women with hypoxemia after pregnancy is significantly reduced, and there is no difference between the level of TSH and the level of TSH in the late pregnancy of the normal pregnant women. It indicates that the treatment is effective. (2) the combination of pregnancy with low T4 and gestational diabetes and low birth weight of the newborn is related to the adverse outcome of pregnancy, and the pregnancy detection and adjustment of the level of FT4 are of great significance or pregnancy. The detection of thyroid function and timely treatment of hypothyroidemia is of great significance. (3) the incidence of hypothyroidism in neonates with low T4 in untreated pregnant women is significantly higher than that in the treatment group and the normal group of pregnant women. (4) the serum TSH level of the newborn infants with pregnancy combined with low T4 is higher than that of the serum TSH water of the normal pregnant women. The incidence of hypothyroidism in pregnant women's pregnancy is high, and the incidence of hypothyroidism and subclinical hypothyroidism is high. It is important to carry out thyroid function screening and monitor thyroid function timely, to treat thyroid disease, to reduce pregnancy complications, complications and adverse outcomes of pregnant women and neonates during pregnancy. Righteousness.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.254
本文编号：2159765
[Abstract]:Objective to investigate the incidence of hypothyroidemia in pregnant women and the adverse effects on pregnant women and newborns by detecting the level of serum thyrotropin (TSH) and free thyroxine (FT4) during the middle and late pregnancy of pregnant women, and to provide the basis for the timely discovery and treatment of women with hypothyroidemia in pregnancy.
The objective of the study was to review the clinical data of 141 pregnant women and their neonates in the obstetrics outpatient department of Guangxi Medical University from January 2013 to 2013 as the study group (72 cases in the treatment group and 69 cases in the untreated group). 58 cases were randomly selected and divided in our hospital during the same period. 10 cases were randomly selected and divided in our hospital. The pregnant women without thyroid dysfunction and without other complications were used as control group.
The study method was used to determine the level of free thyroxine (FT4) and thyroid stimulating hormone (TSH) in the late pregnancy, in the treatment group, the untreated group and the normal group, and to further understand the changes in the middle trimester of pregnancy and the advanced thyroid function (or difference); the incidence of complications and adverse outcomes of pregnant women in each group were compared. The general situation of newborn birth and serum free thyroxine (FT4) and thyroid stimulating hormone (TSH) level 72 hours after birth.
Results (1) the changes in serum TSH and FT4 during pregnancy: mid pregnancy: the mean value of TSH in the treatment group and the untreated group was higher than that in the normal group, the difference was statistically significant (P0.05). The TSH in the untreated group was significantly higher than the TSH in the treatment group and the normal group (P0.05), but there was no statistical difference between the treatment group and the normal control group. Significance (P0.05), middle and late pregnancy: the mean value of FT4 in the treatment group was lower than that of the normal group FT4, the difference was statistically significant (P0.05), but the difference was statistically significant (P0.05) compared with those in the untreated group (P0.05). (2) the incidence of hypothyroidism in pregnant women in the untreated group was significantly higher than that of the treatment group. The difference between the pregnant women in the normal group was statistically significant (P0.05). The prevalence rate of gestational diabetes in the untreated group was significantly higher than that in the treatment group and the normal group. The difference was statistically significant (P0.05). The prevalence rate of pregnancy induced hypertension in the treatment group and the untreated group was significantly higher than that in the normal group (P0.05). The proportion of birth weight 2500g of pregnant women in the group and untreated group was significantly higher than that of the normal group, and the difference was statistically significant (P0.05). But in the comparison group, the weight of the newborn babies born in the untreated group and the normal group were not statistically significant (P0.05). (P0.05). (4) the pregnant women in the untreated group had no statistical significance (P0.05). The incidence of hypothyroidism in newborn infants was significantly higher than that in the treatment group and the normal group. The difference was statistically significant (P0.05). The serum TSH level of the newborns in the treatment group and the untreated group was significantly higher than that of the normal group, and the difference was statistically significant (P0.05), but the treatment group and the untreated group were pregnant women. There was no significant difference in the level of serum TSH in newborn infants (P0.05). Compared with the treatment group, there was no significant difference in serum FT4 level between the untreated group and the normal group (P0.05).
Conclusions (1) the level of TSH in pregnant women with hypoxemia after pregnancy is significantly reduced, and there is no difference between the level of TSH and the level of TSH in the late pregnancy of the normal pregnant women. It indicates that the treatment is effective. (2) the combination of pregnancy with low T4 and gestational diabetes and low birth weight of the newborn is related to the adverse outcome of pregnancy, and the pregnancy detection and adjustment of the level of FT4 are of great significance or pregnancy. The detection of thyroid function and timely treatment of hypothyroidemia is of great significance. (3) the incidence of hypothyroidism in neonates with low T4 in untreated pregnant women is significantly higher than that in the treatment group and the normal group of pregnant women. (4) the serum TSH level of the newborn infants with pregnancy combined with low T4 is higher than that of the serum TSH water of the normal pregnant women. The incidence of hypothyroidism in pregnant women's pregnancy is high, and the incidence of hypothyroidism and subclinical hypothyroidism is high. It is important to carry out thyroid function screening and monitor thyroid function timely, to treat thyroid disease, to reduce pregnancy complications, complications and adverse outcomes of pregnant women and neonates during pregnancy. Righteousness.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.254
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