TPOAb状态与妊娠期亚临床甲状腺功能减退患者妊娠结局的关系

Relationship of the status of TPOAb and the outcome of patients with subclinical hypothyroidism during pregnancy

目的讨论TPOAb状态与妊娠期亚临床甲状腺功能减退(subclincinal hypothyroidism,SCH)患者妊娠结局的相关性,并研究干预治疗对妊娠结局的影响。方法选择2017年10月到2021年6月在邵阳学院附属第二医院产科门诊建档并定期产检的孕妇,根据甲状腺功能减退结果,选择SCH患者220例、对照组1100例,将SCH患者随机分为治疗组和未治疗组,对比两组不良妊娠率的差异及其分别与对照组的差异。同时将SCH组分为TPOAb阳性组和阴性组,分别将两组患者不良妊娠率及其与对照组的患病率进行对比,分析差异是否有统计学意义。采用卡方检验进行率的比较。结果共4203例孕妇接受了甲状腺功能筛查,SCH 220例(5.23%),其中TPOAb阳性90例(40.90%),阴性130例(59.10%)。SCH患者未经治疗的不良妊娠率高于对照组(P<0.05),经左甲状腺素钠片治疗后预后与对照组比较差异无统计学意义(P>0.05);SCH合并TPOAb阳性患者经干预治疗后患病率明显低于未治疗者,差异有统计学意义(P<0.05);SCH合并TPOAb阴性患者经治疗后患病率低于未治疗组,差异无统计学意义(P>0.05)。结论TPOAb阳性患者与妊娠期SCA的结局有明显相关性,经左甲状腺素钠片治疗后可明显减少不良妊娠发生的概率。

Objective To investigate the correlation of thyroid TPOAb status and outcome of patients with subclinical hypothyroidism in pregnancy.Methods Pregnant women who were enrolled in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Shaoyang University from October 2017 to June 2021 were selected for regular physical examination.According to the results of thyroid function,220 women with SCH and 1100 cases were chosen,and the difference in adverse pregnancy rates between the two groups and whether the differences between the two groups were statistically significant were compared with the control group.The SCH group was further divided into a TPOAb positive group and a negative groups.The adverse pregnancy rates of the treated and observed patients in the two groups were compared with the prevalence rates of the control group,and the difference was analyzed whether there was statistical significance by χ^(2) test.Chi-square test was used to compare the rates.Results 4203 pregnant women were screened for thyroid function,of which 90 cases(40.90%)were TPOAb-positive and 130 cases(59.10%)were negative.The prevalence of SCH untreated group was higher than the control group(P<0.05),and the treated group got a similar prognosis(P>0.05).The prevalence of SCH combined with TPOAb-positive patients after intervention was significantly lower than that of untreated patients(P<0.05),while the prevalence of SCH combined with TPOAb-negative patients after treatment was lower than that of untreated group(P>0.05).Conclusion Patients with subclinical hypothyroidism during pregnancy can significantly reduce the incidence of adverse pregnancy after treatment,and the incidence of adverse pregnancy in such patients is significantly reduced after treatment with levothyroxine sodium tablets.