过氧化物酶抗体在妊娠甲状腺功能紊乱发生中的诊断价值

Application value of serum thyroid peroxidase in screening thyroid dysfunction in pregnancy

目的探讨血清甲状腺过氧化物酶抗体(TPOAb)在筛查孕妇发生自身免疫性甲状腺功能紊乱中的诊断价值。方法选取确诊甲状腺功能紊乱的孕妇75例,非甲状腺功能紊乱孕妇145例,采用微粒子酶免疫分析法(MEIA)和化学发光微粒子免疫分析法(CMIA)分别测定血清甲状腺过氧化物酶抗体(TPOAb)水平和促甲状腺激素(TSH)水平。结果(1)甲状腺功能紊乱组血清TSH和TPOAb水平与非紊乱组比较,差异均有统计学意义(P<0.01);(2)甲状腺功能紊乱组中TPOAb呈较高的阳性率(84.0%),非紊乱组孕妇TPOAb阳性率达11.0%;(3)TSH异常组中约半数孕妇(53.3%)呈TPOAb阳性。TSH正常组中有14.5%孕妇TPOAb呈阳性反应;(4)TPOAb阳性组中有65.6%的孕妇出现TSH紊乱;(5)较高TSH水平(>4.67mIU/L)组中,TPOAb阳性率较高(55.7%),低TSH水平组(<0.47mIU/L)中TPOAb阳性率则较低(9.9%);(6)各组高龄孕妇与育龄孕妇组之间血清TSH和TPOAb水平差异无统计学意义(P>0.05)。结论TPOAb可作为孕妇产前监测指标,有助于临床早期诊断并明确妊娠期甲状腺功能紊乱的病因。从诊断价值上看,TSH并不能完全取代TPOAb检测。TPOAb异常可能预示孕妇发生自身免疫性甲状腺疾病的可能和风险。

Objective To research the clinical value of serum thyroid peroxidase （TPOAb） in screening thyroid dysfunction in pregnancy. Methods The concentration of serum TPOAb and TSH （thyroid-stimulating hormone） was detected by MEIA and CMIA in 75 cases of pregnant women with thyroid disfunction,and 145 cases of pregnant women without tyhroid dysfunction （as control group）. Results There were significant differences in both TSH and TPOAb levels between pregnant women with and without thyroid dysfunetion（P〈0.01 ）. The positive rate of TPOAb in patients with thyroid dysfunction was 84.0% ,much higher than 11.0% in those without thyroid dysfunction （P〈0.01）. The positive rates of TPOAb in patients with and without abnormal TSH were 53.3% and 14.5% respectively. About 65.6% pregnant women with TPOAb positive had abnormal TSH. The positive rate of TPOAb in patients with TSH higher than 4.67mIU/L was 55.7% , higher than 9.9% in those with TSH lower than 0.47 mIU/L. Neither serum TPOAb nor serum TSH had significant difference between the group of pregnant women older than 35 and the group under 35 （P〉0.05）. So the nor mal serum TSH could not completely exclude the thyroid dysfunction in pregnant women. Conclusion TPOAb can be used as a prenatal screening marker for early diagnosis of thyroid dysfunction in pregnancy. From the diagnostic point, TSH can not completely substitute for TPOAb and the abnormal TPOAb can indicate the possibility and risk for autoimmune thyroid disease in pregnant women.