深圳市孕妇妊娠早期AITD初筛与监测

Screening and Monitoring of Auto-Immune Thyroid Disease (AITD) During Early Pregnancy in Shen Zhen City

目的:探讨深圳市孕妇自身免疫性甲状腺疾病(AITD)的发病情况,建立定期监测机制和科学干预方案,提高出生人口素质。方法:检测孕妇妊娠早期(12～20)周血清TSH、TPO-Ab水平,必要时进行FT3、FT4检测及其它辅助检查;根据检测结果进行相应定期监测和干预处理。结果:262例孕妇中TSH>5.5μIU/ml7例,占2.67%;TSH<0.35μIU/ml2例,占0.76%。TPO-Ab阳性25例,占9.54%。需定期监测25例,需干预处理16例。结论:深圳市孕妇AITD发病率约3.44%,需要对妊娠早期孕妇进行AITD系统性筛查、监测和科学干预。

Objective To screen the incidence of AITD in early pregnant women and provide necessary intervention. Methods Serum TSH （with CLIA） and TPO -Ab （with RIA） levels were measured in 262 pregnant women during 12 -20 wks gestation. FT3 and FF4 levels were furthur determined in the following subjects： ① TSH 2.8 ～ 5.5μIU/ml with positive TPO - Ab （ n = 7 ） ② TSH 〉 5.5μIU/ml with positive （ n = 5） or negative （ n = 2） TPO - Ab and ③ TSH 〈 0.35 μIU/ml with positive TPO - Ab （ n = 2）. Results Serum TPO -Ab was positive in 25 subjects （9.54%）, suggesting possible presence of AITD. In the 25 subjects, 11 had their TSH levels within normal range （0.35 ～ 2.8μIU/ml） and were left for follow-up with repeated TSH levels determinations every 3 ～ 6 months. TSH levels in 7 women were high -normal （2.8 -5.51μIU/ml） and FT4 levels were low -normal. We believed that early intervention was desirable and LT4 were administered. In all the seven women with TSH levels above 5.5μIU/ml （TPO -Ab positive in 5 of them）, the FT4 levels were lower than normal and would be designated as subclinical hypothyroidism. LT4 treatment was given. Besides, 2 subjects with TPO - Ab positive and TSH levels below 0.35μIU/ml had high FT3 and FT4 levels and received propyl thiouracil treatment as cases of subclinical hyperthyroidism. Therefore, intervention was implemented in 16 cases altogether. Conclusion In this study, the incidence of AITD in 262 early pregnant women was 3.44% （9/262, 7 subclinical hypothyroidism and 2 subclinical hyper thyroidism）. General screening for AITD during early pregnancy seems to be desirable.