血清TSH、FT4指导妊娠期亚临床甲减的临床治疗及对母儿结局的预测分析

Analysis of serum TSH and FT to guide clinical treatment and predict mother and child outcomes in patients with sub-clinical hypothyroidism during pregnancy

目的探讨血清促甲状腺素(TSH)、游离甲状腺素(FT4)对妊娠期亚临床甲减患者临床治疗的指导作用,并分析二者对母儿结局的预测价值。方法回顾性分析512例妊娠期亚临床甲减患者的临床资料,其中孕期根据血清TSH、FT4指导治疗者共162例,记为A组;采用常规治疗者共258例,记为B组;未及时发现病情,孕期未接受治疗者112例,记为C组。对比A组和B组血清TSH、FT4水平;对比3组不良母儿结局发生率;分析血清TSH联合FT4预测A+B组患者不良母体、围产儿妊娠结局的效能。结果A组血清TSH水平低于B组(P<0.05),血清FT4水平高于B组(P<0.05);A组、B组、C组母体不良妊娠结局发生率分别为2.47%、6.98%、24.11%,A组低于B组、C组(P<0.01),B组低于C组(P<0.01);血清TSH、FT4水平联合预测A+B组母体不良妊娠结局的准确度、AUC分别为82.93%、0.876,均分别高于单独预测;A组、B组和C组围产儿不良妊娠结局发生率分别为1.23%、3.52%、10.19%,A组低于B组、C组(P<0.01),B组低于C组(P<0.01);血清TSH、FT4水平联合预测A+B组围产儿不良妊娠结局的准确度、AUC分别为89.71%、0.802,均分别高于单独预测。结论针对妊娠期亚临床甲减患者应根据血清TSH、FT4水平指导临床治疗,常规治疗或孕期未治疗者母儿不良妊娠结局的发生率高,尤其是后者,且二者联合均可预测母儿不良妊娠结局。

Objective:To explore the guiding role of serum TSH and FT4 in the clinical treatment of subclinical hypothyroidism during pregnancy and to analyze on their predictive value of mother and child outcomes.Methods:The clinical data of 512 cases of subclinical hypothyroidism in pregnancy were reviewed.162 cases were treated according to TSH and FT4 during pregnancy,which were recorded as group A.258 cases were treated with routine therapy,and they were recorded as group B.112 cases who did not receive treatment during pregnancy were recorded as group C.The serum TSH and FT4 levels between group A and group B were compared.The incidences of adverse maternal and perinatal outcomes were compared among the three groups.The efficacy of serum TSH combined with FT4 in predicting the adverse maternal and perinatal pregnancy outcome in group A+B was evaluated.Results:The serum TSH level of group A was lower than that of group B(P<0.05),and the serum FT4 level was higher than that of group B(P<0.05).The incidence of adverse pregnancy outcomes in group A,B and C was 2.47%,6.98%and 24.11%,respectively,which was lower in group A than those in group B and C(P<0.01),which in group B was lower than in group C(P<0.01).The accuracy and AUC of serum TSH and FT4 combined prediction of adverse mother outcomes were 82.93%and 0.876,respectively.The incidence of adverse pregnancy outcomes in group A,B and C were 1.23%,3.52%and 10.19%respectively,which were lower in group A than in group B and C(P<0.01),and lower in group B than in group C(P<0.01).The accuracy and AUC of serum TSH and FT4 combined prediction of adverse child outcomes of group A+B were 89.71%and 0.802,respectively,which were higher than those of single prediction.Conclusion:For the patients with subclinical hypothyroidism during pregnancy,the clinical treatment should be guided according to the serum TSH and FT4 levels.The incidence of adverse pregnancy outcomes of mothers and perinatal infants is high,especially the latter,and the combination of the two can predict adverse pregnancy outcomes of mothers and child.