孕妇甲状腺功能异常筛查及甲状腺自身免疫功能分析

Screening of thyroid dysfunction and analysis of thyroid autoimmune function in pregnant women

目的观察妊娠早期孕妇甲状腺功能异常情况并分析其甲状腺自身免疫功能。方法以2019年1月-2020年1月在我院进行甲状腺功能检查的妊娠早期孕妇97例为研究对象,其中甲状腺功能减退9例,甲状腺功能正常80例,甲状腺功能亢进8例;根据甲状腺过氧化物酶抗体(TPOAb)水平分为TPOAb阳性组(21例)和TPOAb阴性组(76例)。检测血清促甲状腺激素(TSH)、血清游离三碘甲状原氨酸(FT3)、血清游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb)水平,对所有孕妇的妊娠结局及并发症进行随访和分析。结果和甲状腺功能正常孕妇相比,甲状腺功能减低孕妇中血清TSH水平升高,FT3、FT4水平降低,TPOAb水平升高,甲状腺功能亢进孕妇中血清TSH水平降低,FT3、FT4水平升高,TPOAb水平升高,差异均有统计学意义(P<0.05);TPOAb阳性孕妇的TSH、FT3、FT4异常率均高于TPOAb阴性孕妇,差异有统计学意义(P<0.05);TPOAb阳性孕妇的流产、早产、新生儿窒息、低体质量儿的发生率高于TPOAb正常孕妇,差异有统计学意义(P<0.05)。结论妊娠早期甲状腺功能异常患者的血清甲状腺自身免疫抗体水平升高,TPOAb阳性增加不良妊娠结局的发生率,可通过加强筛查和检测以及早进行临床诊断和干预。

Objective To observe the abnormal thyroid function of pregnant women in early pregnancy and analyze their thyroid autoimmune function.Methods 97 early pregnant women who underwent thyroid function examination in our hospital from January 2019 to January 2020 were studied,including 9 cases of hypothyroidism,80 cases of normal thyroid function and 8 cases of hyperthyroidism;According to the level of thyroid peroxidase antibody(TPOAb),they were divided into TPOAb positive group(21 cases)and TPOAb negative group(76 cases).The levels of serum thyroid stimulating hormone(TSH),serum free triiodothyronine(FT3),serum free thyroxine(FT4)and thyroid peroxidase antibody(TPOAb)were measured.The pregnancy outcomes and complications of all pregnant women were followed up and analyzed.Results Compared with pregnant women with normal thyroid function,the levels of serum TSH increased,FT3 and FT4 decreased,TPOAb increased in pregnant women with hypothyroidism,and the levels of serum TSH decreased,FT3 and FT4 increased,TPOAb increased in pregnant women with hyperthyroidism(P<0.05);The abnormal rates of TSH,FT3 and FT4 in TPOAb positive pregnant women were significantly higher than those in TPOAb negative pregnant women(P<0.05);The incidence of abortion,premature delivery,neonatal asphyxia and low body weight infants in TPOAb positive pregnant women was significantly higher than that in TPOAb normal pregnant women(P<0.05).Conclusion The level of serum thyroid autoimmune antibody in patients with abnormal thyroid function in early pregnancy increases,and TPOAb positive increases the incidence of adverse pregnancy outcomes.It can be diagnosed and intervened early by strengthening screening and detection.