妊娠妇女自身免疫性甲状腺疾病筛查、监测和干预研究

Screening,monitoring and intervention of autoimmune thyroid disease in pregnant women during first trimester and second trimester of pregnancy in Shenzhen City

目的调查深圳市妊娠早中期妇女自身免疫性甲状腺疾病（AITD）的发病情况，探索建立筛查、监测、干预机制，预防孕母甲状腺功能紊乱特别是甲低对胎儿发育的损害。方法检测深圳市妊娠早中期妇女（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，按照设定流程进行必要的监测和干预。结果361例被调查者中，共发现10例临床甲低（2．78％），6例临床甲亢（1．66％），初次筛查TPO-Ab阳性率14．13％（51／361），初次筛查TSH异常率5．26％（19／361），发病率和阳性率与AITD家族史密切相关。结论对妊娠早中期妇女进行AITD系统筛查、监测十分必要，应当将TSH和TPO-Ab检测作为孕期保健的常规项目。

Objective To investigate the occurrence of Auto - immune Thyroid Disease （AITD） in pregnant women during first trimester and second trimester of pregnancy in Shenzhen City, and probed establish the mechanism of screening,monitoring and intervention ,to avoid the damages to fetuses in mothers with disordered thyroid function especially with hypothyroidism. Methods The levels of serum thyroid Stimulating Hormone （TSH） and thyroid peroxidase antibodies （TPO - Ab） were detected in women at the first and second trimester of pregnancy. Free triiodthyroxine （ FT3 ）, Free thyroxine （FT4） measurements and other assistant examinations were taken if necessary. Monitoring and intervening measurements were taken according to the levels of TSH and TPO - Ab during first trimester and second trimester of pregnancy. Results Out of the 261 cases surveyed, 10 clinical hypothyroidism cases （2.78%） were detected and 6 clinical hyperthyroidism cases （1.66%） were detected. The initial positive rate of TPO - Ab was 14.13% （51/361） and the initial abormal value of TSH was observed in 5.26% （19/361） of the cases. The incidence and positive rates were associated with the familial history of AITD. Conclusion It＇s quite necessary to systemically screen and monitor AITD in pregnant women during first trimester and second trimester of pregnancy in Shenzhen city. Detection of TPO - Ab and TSH be routinely carried out during antenatal care.