妊娠合并亚临床甲状腺功能减退27例病例分析
发布时间：2018-08-02 18:07
【摘要】：目的探讨甲状腺过氧化物酶抗体在亚甲减孕妇中的意义、激素治疗对亚甲减孕妇不良妊娠事件的影响,对妊娠妇女规范甲状腺疾病的筛查,早期诊断,早期治疗,减少妊娠并发症及不良妊娠结局的发生。方法选取2015年12月至2016年12月于大连医科大学附属第二医院产检及终止妊娠的孕产妇,根据甲状腺功能筛选出合并亚临床甲状腺功能减退患者27例,回顾性分析其临床病例资料,资料包括患者年龄、首次发现甲状腺功能异常的孕周、合并TPOAb(thyroid peroxidase antibody,甲状腺过氧化物酶抗体)的情况、治疗情况及妊娠情况。使用SPSS 19.0统计学软件进行分析,用spearman相关系数分别对患者的年龄与TPOAb之间的相关性、首次发现甲状腺功能异常的孕周与TPOAb之间的相关性进行分析。同时按照TPOAb的情况分为两组,在两组内比较治疗对于不良妊娠事件的影响。应用卡方检验分别对两组内不良妊娠事件的发生率进行比较,P0.05为差异具有统计学意义。结果1.27例妊娠合并亚临床甲状腺功能减退患者中,TPOAb(+)的患者共14例,其中经左旋甲状腺素系统治疗的患者10例,未经治疗者4例;TPOAb(-)的患者共13例,其中经左旋甲状腺素系统治疗的患者10例,未经治疗者3例。Spearman相关系数分析显示,年龄与TPOAb的相关系数为0.408,呈正相关,P=0.035,具有统计学意义。2.27例妊娠合并亚临床甲状腺功能减退患者中,孕早期(孕1~13周末)诊断为亚临床甲状腺功能减退者21例,孕中期(孕14~27周末)诊断为亚临床甲状腺功能减退者2例,孕晚期(孕28~39周末)诊断为亚临床甲状腺功能减退者4例。Spearman相关系数分析显示,孕周与TPOAb的相关系数为0.186,呈正相关,P=0.352,不具有统计学意义。3.TPOAb(+)的患者中,经甲状腺素钠片治疗后,不良妊娠事件的发生率明显低于未治疗的患者(P0.05),差异具有统计学意义。TPOAb(-)的患者中,经甲状腺素钠片治疗与未治疗者之间,不良妊娠结局的发生无统计学差异(P0.05)。结论1.TPOAb与患者的年龄呈正相关,具有统计学意义。年龄越大,TPOAb出现的可能性越大。患者首次发现亚甲减的孕周与TPOAb之间未见统计学意义的相关性。2.妊娠期亚临床甲状腺功能减退患者中,TPOAb(+)的患者中,经过甲状腺素钠片治疗的患者比之未经治疗的患者,其不良妊娠事件的比例明显降低。而TPOAb(-)的患者中,治疗组与未治疗组之间未见明显差异。3.由于亚临床甲状腺功能减退的患者往往不具备典型的临床症状,因此应该对所有孕期妇女规范产前检查,尽早对亚临床甲状腺功能减退的患者进行诊断,根据我国指南尽早予以甲状腺素钠片治疗,从而减少不良妊娠事件的发生。
[Abstract]:Objective to investigate the significance of thyroid peroxidase antibody in pregnant women with hypothyroidism, the effect of hormone therapy on adverse pregnancy events of hypothyroidism pregnant women, and the screening, early diagnosis and early treatment of thyroid diseases in pregnant women. To reduce the incidence of pregnancy complications and adverse pregnancy outcomes. Methods 27 women with subclinical hypothyroidism were selected from the second affiliated Hospital of Dalian Medical University from December 2015 to December 2016. The clinical data were analyzed retrospectively, including age of patients, gestational weeks in which thyroid dysfunction was found for the first time, TPOAb (thyroid peroxidase antibody, thyroid peroxidase antibody), treatment and pregnancy. SPSS 19.0 software was used to analyze the correlation between age and TPOAb with spearman correlation coefficient, and the correlation between gestational age of thyroid dysfunction and TPOAb was found for the first time. The patients were divided into two groups according to TPOAb, and the effects of treatment on adverse pregnancy events were compared between the two groups. Chi-square test was used to compare the incidence of adverse pregnancy events between the two groups. Results 1.There were 14 cases of TPOAb (-) in 27 cases of pregnancy complicated with subclinical hypothyroidism, including 10 cases treated with levothyroxine system and 13 cases with TPOAb (-) without treatment. Among them, 10 patients were treated with levothyroxine system, and 3 patients were not treated. Spearman correlation coefficient analysis showed that, The correlation coefficient between age and TPOAb was 0.408, and the positive correlation was 0.035. Among the 27 cases of pregnancy complicated with subclinical hypothyroidism, 21 cases were diagnosed as subclinical hypothyroidism at the first trimester of pregnancy. The subclinical hypothyroidism was diagnosed in 2 cases at the second trimester of pregnancy (at the end of 27 weeks of pregnancy) and in 4 cases with subclinical hypothyroidism at the late trimester (week 2839 of pregnancy). The Spearman correlation coefficient analysis showed that subclinical hypothyroidism was found in 2 cases. The correlation coefficient between gestational age and TPOAb was 0.186.A positive correlation was 0.352. The incidence of adverse pregnancy events was significantly lower than that of untreated patients (P0.05). There was no significant difference in the occurrence of adverse pregnancy outcomes between the patients treated with TPOAb (-) and those treated with thyroxine sodium tablets (P0.05). Conclusion 1.TPOAb is positively correlated with the age of the patients. The older the age, the more likely TPOAb will appear. There was no statistically significant correlation between the gestational age of hypothyroidism and TPOAb for the first time. Among the patients with subclinical hypothyroidism during pregnancy, the proportion of adverse pregnancy events in patients treated with thyroxine sodium tablets was significantly lower than that in untreated patients. However, there was no significant difference between the treatment group and the untreated group in TPOAb (-). Because subclinical hypothyroidism patients often do not have typical clinical symptoms, all pregnant women should be standardized prenatal examination, early diagnosis of subclinical hypothyroidism patients, According to our guidelines, thyroxine sodium tablets are given as early as possible, thus reducing the occurrence of adverse pregnancy events.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256
本文编号：2160249
[Abstract]:Objective to investigate the significance of thyroid peroxidase antibody in pregnant women with hypothyroidism, the effect of hormone therapy on adverse pregnancy events of hypothyroidism pregnant women, and the screening, early diagnosis and early treatment of thyroid diseases in pregnant women. To reduce the incidence of pregnancy complications and adverse pregnancy outcomes. Methods 27 women with subclinical hypothyroidism were selected from the second affiliated Hospital of Dalian Medical University from December 2015 to December 2016. The clinical data were analyzed retrospectively, including age of patients, gestational weeks in which thyroid dysfunction was found for the first time, TPOAb (thyroid peroxidase antibody, thyroid peroxidase antibody), treatment and pregnancy. SPSS 19.0 software was used to analyze the correlation between age and TPOAb with spearman correlation coefficient, and the correlation between gestational age of thyroid dysfunction and TPOAb was found for the first time. The patients were divided into two groups according to TPOAb, and the effects of treatment on adverse pregnancy events were compared between the two groups. Chi-square test was used to compare the incidence of adverse pregnancy events between the two groups. Results 1.There were 14 cases of TPOAb (-) in 27 cases of pregnancy complicated with subclinical hypothyroidism, including 10 cases treated with levothyroxine system and 13 cases with TPOAb (-) without treatment. Among them, 10 patients were treated with levothyroxine system, and 3 patients were not treated. Spearman correlation coefficient analysis showed that, The correlation coefficient between age and TPOAb was 0.408, and the positive correlation was 0.035. Among the 27 cases of pregnancy complicated with subclinical hypothyroidism, 21 cases were diagnosed as subclinical hypothyroidism at the first trimester of pregnancy. The subclinical hypothyroidism was diagnosed in 2 cases at the second trimester of pregnancy (at the end of 27 weeks of pregnancy) and in 4 cases with subclinical hypothyroidism at the late trimester (week 2839 of pregnancy). The Spearman correlation coefficient analysis showed that subclinical hypothyroidism was found in 2 cases. The correlation coefficient between gestational age and TPOAb was 0.186.A positive correlation was 0.352. The incidence of adverse pregnancy events was significantly lower than that of untreated patients (P0.05). There was no significant difference in the occurrence of adverse pregnancy outcomes between the patients treated with TPOAb (-) and those treated with thyroxine sodium tablets (P0.05). Conclusion 1.TPOAb is positively correlated with the age of the patients. The older the age, the more likely TPOAb will appear. There was no statistically significant correlation between the gestational age of hypothyroidism and TPOAb for the first time. Among the patients with subclinical hypothyroidism during pregnancy, the proportion of adverse pregnancy events in patients treated with thyroxine sodium tablets was significantly lower than that in untreated patients. However, there was no significant difference between the treatment group and the untreated group in TPOAb (-). Because subclinical hypothyroidism patients often do not have typical clinical symptoms, all pregnant women should be standardized prenatal examination, early diagnosis of subclinical hypothyroidism patients, According to our guidelines, thyroxine sodium tablets are given as early as possible, thus reducing the occurrence of adverse pregnancy events.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256
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