亚临床甲减及TPOAb阳性对孕妇子痫前期临床结局的影响

Health effects of subclinical hypothyroidism and TPOAb positive on clinical outcome of preeclampsia in pregnant women

目的研究亚临床甲减及甲状腺过氧化物酶抗体(TPOAb)阳性对子痫前期临床结局的影响。方法回顾性选取2017年1月至2019年12月在成都市武侯区人民医院门诊收治的236例妊娠期亚临床甲减和(或)TPOAb阳性孕妇临床资料,根据促甲状腺素(TSH)及TPOAb检查结果将所有孕妇分为3组,即亚临床甲减+TPOAb阳性组、亚临床甲减+TPOAb阴性组及仅TPOAb阳性组,同期纳入健康孕妇作为对照组。比较4组孕妇在妊娠并发症(亚临床甲减、临床甲减、妊娠高血压、子痫前期、妊娠糖尿病)的发生率和妊娠结局(先兆流产、早产、胎儿宫内窘迫、胎膜早破、胎盘早剥、剖宫产、产后出血)的差异及新生儿临床指标(低体重儿、巨大儿、Apgar评分)及TSH的差异。结果4组间妊娠期并发症发生率差异有统计学意义(P<0.05);与对照组相比,亚临床甲减+TPOAb阳性组临床甲减、妊娠高血压、子痫前期、妊娠糖尿病的发生率、亚临床甲减+TPOAB阴性组临床甲减的发生率及仅TPOAB阳性组临床甲减、妊娠高血压、子痫前期的发生率均明显升高;与亚临床甲减+TPOAb阴性组相比,亚临床甲减+TPOAB阳性组临床甲减、妊娠高血压、子痫前期的发生率,仅TPOAB阳性组临床甲减的发生率明显升高,差异均有统计学意义(P<0.05);仅TPOAB阳性组临床甲减的发生率较亚临床甲减+TPOAb阴性组低,而在妊娠高血压和子痫前期的发生率较高;以上差异均有统计学意义(P<0.05)。4组在先兆流产、早产的发生率方面比较差异有统计学意义(P<0.05);亚临床甲减+TPOAB阴性组与仅TPOAB阳性组先兆流产及早产的发生率较亚临床甲减+TPOAB阴性组与对照组高,组间比较差异均有统计学意义(P<0.05)。亚临床甲减+TPOAb阳性组在低体重儿的发生率及TSH指标均高于其余3组,但差异无统计学意义(P>0.05)。结论亚临床甲减和(或)TPOAb阳性可引起孕妇子痫前期妊娠不良结局增加。

Objective To study the effect of subclinical hypothyroidism and TPOAb on the clinical outcome of preeclampsia.Methods From January 2017 to December 2019,236 pregnant women with subclinical hypothyroidism and/or TPOAB-positive pregnancy were selected from Wuhou District People's Hospital of Chengdu,and were divided into subclinical hypothyroidism+TPOAb(+)group,subclinical hypothyroidism+TPOA(-)group and TPOAb(+)group.The incidence of pregnancy complications(subclinical hypothyroidism,clinical hypothyroidism,pregnancy-induced hypertension,preeclampsia,gestational diabetes mellitus)and pregnancy outcomes(threatened abortion,premature delivery,fetal distress,premature rupture of membranes,placental abruption,cesarean section,postpartum hemorrhage)were compared among the four groups of pregnant women,and the neonatal clinical indicators(low birth weight,macrosomia,Apgar score)and thyroid finger(TSH)were compared.Results The incidence of pregnancy complications was significantly different between the four groups(P<0.05).Compared with the control group,the incidence of clinical hypothyroidism,gestational hypertension,preeclampsia and gestational diabetes mellitus in the subclinical hypothyroidism+TPOAb(+)group,the incidence of clinical hypothyroidism in subclinical hypothyroidism+TPOAb(+)group and the incidence of subclinical hypothyroidism,clinical hypothyroidism,pregnancy-induced hypertension and preeclampsia in only TPOAb(+)group were significantly higher;Compared with subclinical hypothyroidism+TPOAb(-)group,the incidence of subclinical hypothyroidism+TPOAb(+)group in clinical hypothyroidism,pregnancy hypertension,preeclampsia and only TPOAb(+)group in clinical hypothyroidism were significantly decreased;Compared with the subclinical hypothyroidism+TPOAb(-)group,only TPOAb(+)group had lower incidence of hypothyroidism,but higher incidence of pregnancy-induced hypertension and preeclampsia(P<0.05);All above differences were statistically significant(P<0.05).The incidence of threatened abortion and premature delivery among the four groups.Compared with the control group,the incidence of threatened abortion and premature delivery in the subclinical hypothyroidism+TPOAb(+)group and only TPOAb(+)group was significantly increased;the incidence of threatened abortion and premature delivery in subclinical hypothyroidism+TPOAb(+)group and only TPOAb(+)group were higher than that in subclinical hypothyroidism+TPOAb(-)group and the control group(P<0.05).The incidence of low birth weight infants and TSH in subclinical hypothyroidism+TPOAb(+)group were higher than those in the other three groups,but there was no significant difference(P>0.05).Conclusion Subclinical hypothyroidism and/or TPOAb positive can increase the adverse pregnancy outcomes of preeclampsia in pregnant women.