妊娠期甲状腺功能减退症患者血清TSH和VB_(12)及Hcy表达水平及其与妊娠结局的关系

Levels of serum TSH,VB_(12)and Hcy and their relationship with pregnancy outcomes in patients with gestational hypothyroidism

目的探讨妊娠期甲状腺功能减退症(简称甲减)患者血清促甲状腺激素(TSH)、维生素B_(12)(VB_(12))、同型半胱氨酸(Hcy)水平及其与妊娠结局的关系。方法选取2017年4月-2020年3月于广元市第一人民医院分娩的85例妊娠期甲减患者作为研究对象,其中35例妊娠期临床甲减患者(妊娠期临床甲减组),50例妊娠期亚临床甲减患者(妊娠期亚临床甲减组);选取40名同期于本院分娩的甲状腺功能正常孕妇作为对照组。比较三组甲状腺功能、血清TSH、VB_(12)、Hcy水平、妊娠结局。85例妊娠期甲减患者根据妊娠结局分为不良妊娠结局组(n=68)和正常妊娠结局组(n=17),比较两组血清TSH、VB_(12)、Hcy水平,分析血清TSH、VB_(12)、Hcy水平与妊娠结局的关系。结果妊娠期临床甲减组、亚临床甲减组游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)及VB12水平均低于对照组,TSH、Hcy水平高于对照组,差异均有统计学意义(P均<0.05);妊娠期临床甲减组FT4、FT3及VB_(12)水平低于亚临床甲减组,TSH、Hcy水平高于亚临床甲减组,差异均有统计学意义(P均<0.05)。妊娠期临床甲减组、亚临床甲减组不良妊娠结局发生率分别为82.86%、78.00%,均高于对照组17.50%,差异有统计学意义(χ^(2)=55.736,P<0.05)。不良妊娠结局组TSH、Hcy水平高于正常妊娠结局组,VB_(12)水平低于正常妊娠结局组,差异有统计学意义(t=8.302、4.828、3.932,P均<0.05)。结论妊娠期甲状腺功能减退症患者FT4、FT3、VB_(12)水平较低,TSH、Hcy水平升高,推测TSH、VB_(12)、Hcy水平对妊娠结局的预测有较高参考价值。

Objective To explore the levels of serum thyroid stimulating hormone(TSH),vitamin B_(12)(VB_(12))and homocysteine(Hcy)and their relationship with pregnancy outcomes in patients with gestational hypothyroidism.Methods A total of 85 patients with gestational hypothyroidism who delivered in Guangyuan First People’s Hospital from April 2017 to March 2020 were enrolled as the research objects,including 35 cases with gestational clinical hypothyroidism(gestational clinical hypothyroidism group)and 50 cases with gestational subclinical hypothyroidism(gestational subclinical hypothyroidism group).Forty pregnant women with normal thyroid function who delivered in Guangyuan First People’s Hospital during the same period were enrolled as control group.Thyroid function,levels of serum TSH,VB_(12)and Hcy,and pregnancy outcomes were compared among the three groups.According to different pregnancy outcomes,the 85 patients with gestational hypothyroidism were divided into adverse pregnancy outcome group(n=68)and normal pregnancy outcome group(n=17).The levels of serum TSH,VB_(12)and Hcy were compared between the two groups.And their relationships with pregnancy outcomes were analyzed.Results The levels of free thyroxine(FT4),free triiodothyronine(FT3)and VB_(12)in gestational clinical hypothyroidism group and gestational subclinical hypothyroidism group were lower than those in control group,while levels of TSH and Hcy higher than those in control group,and the differences were statistically significant(P<0.05).The levels of FT4,FT3 and VB_(12)in gestational clinical hypothyroidism group were lower than those in gestational subclinical hypothyroidism group,while levels of TSH and Hcy higher than those in gestational subclinical hypothyroidism group,and the differences were statistically significant(P<0.05).The incidence of adverse pregnancy outcomes in gestational clinical hypothyroidism group and gestational subclinical hypothyroidism group was higher than that in control group(82.86%,78.00%vs.17.50%),and the differences were statistically significant(χ^(2)=55.736,P<0.05).The levels of TSH and Hcy in adverse pregnancy outcome group were higher than those in normal pregnancy outcome group,while VB_(12)level was lower than that in normal pregnancy outcome group,and the differences were statistically significant(t=8.302,4.828,3.932,P<0.05).Conclusions The levels of FT4,FT3 and VB_(12)were low,while levels of TSH and Hcy were high in patients with gestational hypothyroidism.The levels of TSH,VB_(12)and Hcy might have high reference value for predicting pregnancy outcomes.