妊娠期不同阶段甲状腺功能变化及与TPOAb和25(OH)D的相关性

Thyroid function changes at different stages of pregnancy and its correlations with TPOAb and 25(OH)D

目的分析妊娠期不同阶段孕妇血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺素(TSH)水平变化,及其与甲状腺过氧化物酶抗体(TPOAb)和25羟基维生素D[25(OH)D]的关系。方法将2017年5月-2018年8月在郑州市妇幼保健院进行产前检查的180例孕妇根据孕周不同分为三组:妊娠早期组65例;妊娠中期组55例;妊娠晚期组60例,另选择60例未妊娠健康妇女为对照组。采集受试者肘静脉血,免疫发光法检测血清FT3、FT4、TSH、TPOAb水平,质谱法检测血清25(OH)D水平,比较各组间上述指标的差异,采用Pearson相关系数法分析妊娠期妇女FT3、FT4、TSH与TPOAb、25(OH)D的关系。结果妊娠早、中、晚期组孕妇FT3、FT4、TSH、TPOAb、25(OH)D均低于对照组,其中FT3、FT4随孕期延长呈显著降低趋势,差异均有统计学意义(P<0.05),TSH、TPOAb、25(OH)D随孕期延长呈显著升高趋势,差异有统计学意义(P<0.05);妊娠期三组间TPOAb阳性率比较差异无统计学意义(P>0.05),但TPOAb阳性组FT4低于阴性组,TSH水平高于阴性组,差异均有统计学意义(P<0.05),25(OH)D营养分布情况比较差异有统计学意义(P<0.05),但不同25(OH)D组间FT3、FT4、TSH差异均无统计学意义(P>0.05);妊娠期妇女TPOAb与TSH之间呈显著正相关关系(r=0.513,P=0.014)。结论妊娠早、中、晚期孕妇FT3、FT4水平逐渐降低,TSH水平逐渐升高,具有较高的亚临床甲减发生风险,与TPOAb阳性有关,而与25(OH)D水平无关。

Objective To analyze the changes of serum free triiodothyronine(FT3),free thyroxine(FT4)and thyrotropin(TSH)levels in pregnant women at different stages of pregnancy,and its relationships with thyroid peroxidase antibody(TPOAb)and 25-hydroxy vitamin D[25(OH)D].Methods From May 2017 to August 2018,180 pregnant women were divided into three groups according to their gestational weeks:65 cases in the early pregnancy group,55 cases in the middle pregnancy group,60 cases in the late pregnancy group,and another 60 healthy women without pregnancy were selected as control group.The venous blood was collected from the subjects.And the levels of serum FT3,FT4,TSH and TPOAb were detected by immunoluminescence;Serum 25(OH)D levels were detected by mass spectrometry.The differences between the above indicators were compared;Pearson correlation coefficient method was used to analyze the relationships between FT3,FT4,TSH with TPOAb,25(OH)D in pregnant women.Results FT3,FT4,TSH,TPOAb and 25(OH)D of pregnant women in the early,middle and late pregnancy groups were lower than those in the control group(P<0.05),among them,FT3 and FT4 showed a significant decreasing trend with prolonged pregnancy(P<0.05);TSH,TPOAb and 25(OH)D showed a significant increasing trend with prolonged pregnancy(P<0.05);there was no significant difference in the TPOAb positive rate between the three groups during pregnancy(P>0.05),however,FT4 in TPOAb positive group was lower than that in negative group(P<0.05);the level of TSH was higher than that in the negative group(P<0.05),the difference in 25(OH)D nutrition distribution was statistically significant(P<0.05),however,there was no significant difference in FT3,FT4 and TSH between 25(OH)D groups(P>0.05);there was a significant positive correlation between TPOAb and TSH in pregnant women(r=0.513,P=0.014).Conclusion The levels of FT3 and FT4 gradually decreased in early,middle and late pregnancy;the level of TSH gradually increased,with a higher risk of subclinical hypothyroidism,which was related to TPOAb positivity but not related to 25(OH)D level.