妊娠早期甲状腺过氧化物酶抗体水平对妊娠期妇女及胎儿甲状腺功能、妊娠结局的影响

Influence of thyroid peroxidase antibody levels in early pregnancy on pregnancy outcome and pregnant women's and fetal thyroid function

目的探讨妊娠早期甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)水平对妊娠期妇女及胎儿甲状腺功能、妊娠结局的影响。方法选取2016年1月至2017年6月于武汉市第六医院行早期孕检的孕妇124例为研究对象,根据孕妇入组时TPOAb水平分为3组:阳性A组(9～30 IU/m L,27例)、阳性B组(≥30 IU/m L,21例)和阴性组(≤9 IU/m L,76例)。比较3组孕妇妊娠晚期甲状腺功能、不良妊娠结局、新生儿出生情况及出生后甲状腺功能相关指标。结果阳性A组和B组孕妇妊娠晚期游离甲状腺素(freethyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平均低于阴性组,促甲状腺激素(thyroidstimulating hormone,TSH)水平、甲状腺功能异常及不良妊娠结局发生率均高于阴性组,差异有统计学意义(P <0. 05)。3组新生儿体重、身长、Apgar评分比较,差异均无统计学意义(P> 0. 05)。阳性A组和B组新生儿出生3 d后的FT4、FT3水平均低于阴性组,TSH、TPOAb水平均高于阴性组,且阳性B组的TPOAb水平显著高于A组,差异均有统计学意义(P <0. 05)。阳性B组新生儿出生1月后的FT4、FT3水平均低于阳性A组,TSH、TPOAb水平均高于阳性A组,差异均有统计学意义(P <0. 05)。两组新生儿出生3月后FT4、FT3、TSH及TPOAb水平比较,差异均无统计学意义(P> 0. 05)。结论孕妇妊娠早期TPOAb阳性可能会影响其妊娠结局及新生儿甲状腺功能,可作为临床筛查提示,应予以高度警惕。

Objective To explore the influence of thyroid peroxidase antibody(TPOAb) levels in early pregnancy on pregnancy outcome and pregnant women’s and fetal thyroid function.Methods 124 pregnant women undergoing early pregnancy examination at the Sixth Hospital of Wuhan City from January 2016 to June 2017 were selected and divided into the TPOAb positive A group(9 ~ 30 IU/m L,27 cases),positive B group(≥30 IU/m L,21 cases) and negative group(≤9 IU/m L,76 cases) according to the detection of TPOAb.The gestational thyroid function,adverse pregnancy outcome,and the newborn birth situation and neonatal thyroid function related indicators in the three groups were compared.Results The levels of FT4 and FT3 at late pregnancy in the positive A and B group were significantly lower than that in the negative group,while the level of TSH,the rate of thyroid dysfunction and adverse pregnancy outcome were significantly higher than that in the negative group,all above had statistical differences(P<0.05).There was no statistical difference in the neonatal weight,length and Apgar score among the three groups(P>0.05).The levels of FT4 and FT3 at 3 th day after birth in the positive A and B group were significantly lower than that in the negative group,while the levels of TSH and TPOAb were significantly higher than that in the negative group;the level of TPOAb at 3 th day after birth in the positive B group was significantly higher than that in the positive A group,all above had statistical differences(P<0.05).The levels of FT4 and FT3 at 1 th month after birth in the positive B group was significantly lower than that in the positive A group,while the levels of TSH and TPOAb were significantly higher than that in the positive A group,all above had statistical difference(P<0.05).There was no statistical difference in the levels of FT4,FT3,TSH and TPOAb at 3 th month after birth between the positive A and B groups(P>0.05).Conclusion Maternal positive TPOAb in early pregnancy may affect their pregnancy outcomes and neonatal thyroid function,which could be served as clinical screening tips and should be highly vigilant.