检测Graves病孕妇血清促甲状腺激素受体抗体的临床意义

Clinical significance of the serum level of TSH receptor antibody in pregnant women with Graves' disease

目的探讨Graves病妊娠患者血清促甲状腺激素受体抗体(TRAb)水平和服用抗甲状腺药物(ATDs)对新生儿甲状腺功能异常的影响。方法应用放射性受体法(RRA)和电化学发光免疫分析法(ECLIA)分别检测了68例Graves病孕妇及其新生儿血清TRAb和三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)水平,根据母亲孕期血清TRAb水平和服用ATDs的情况对新生儿甲状腺功能异常发生率及影响因素进行分析。结果新生儿甲状腺功能异常发生率为29.4%(20/68),母亲妊娠晚期TRAb增高组其新生儿甲状腺功能异常发生率显著高于TRAb正常组(P<0.01)。新生儿出生后5～14 d取静脉血测定TRAb和甲状腺功能,23例血清TRAb正常且未服ATDs的孕妇,其新生儿1例发生甲状腺功能异常;45例血清TRAb增高和(或)妊娠期间ATDs治疗的孕妇,其新生儿中19例发生新生儿甲状腺功能异常。结论新生儿甲状腺功能取决于通过胎盘屏障的TRAb与ATDs之间的平衡。Graves病妊娠妇女血清TRAb的测定对评估新生儿甲状腺功能具有重要意义,妊娠晚期血清TRAb水平增高是新生儿甲状腺功能异常的一个危险因素。

Objective： To investigate the clinical significance of serum TSH receptor antibody （TRAb） levels and the antithyroid drug （ATDs） use of pregnant women with Graves＇ disease in their neonatal thyroid function. Methods： The serum TRAb and T3, T4 , FT3, FT4, TSH levels in 68 pregnant women with Graves＇ disease and their newborns were detected by radio receptor assay （RRA） and electrical chemiluminescence immunoassay （ECLIA）, respectively. Based on the maternal serum TRAb levels and the use of antithyroid drugs during pregancy, the newborns were divided into different groups. The incidence of neonatal thyroid dysfunction and its risk factors were analyzed. Results： The results showed the incidence of abnormal thyroid function of newborns was 29.4% （20/ 68）. The proportion of neonatal thyroid dysfunction in women with high TRAb levels in the third trimester of pregnancy were significantly higher than these with normal TRAb （P〈0. 01）. In 23 newborns whose mothers were normal in serum TRAb levels and took no ATDs during pregnancy, only one case had thyroid dysfunction within two weeks after birth, while in other 45 newborns whose mothers had a high level of serum TRAb and/or took ATDs during pregnancy, 19 developed thyroid dysfunction within two weeks after birth. Conclusions： Neonatal thyroid function depends on the balance between the transplacental TRAb and ATDs. TRAb measurement in pregnant women with Graves＇ disease is significant for the evaluation of neonatal thyroid function. Elevated level of serum TRAb in the third trimester of pregnancy is a risk factor for neonatal thyroid dysfunction.