TPO抗体和TSH水平对孕早期妇女妊娠结局的影响与干预研究

Effects of TPO antibodies and TSH levels on pregnancy outcome and intervention studies in early prenant women

目的通过对妊娠早期孕妇甲状腺过氧化物酶抗体(TPOAb)和甲状腺功能的筛查,并对TPOAb阳性的亚临床甲减孕妇予以左旋甲状腺素(L-T4)干预,比较干预治疗是否可以影响妊娠结局和新生儿促甲状腺激素(TSH)的水平。方法选择293例甲状腺功能正常的妊娠早期孕妇作为研究对象,分为TPOAb阳性组、阴性组和干预组。比较TPOAb阳性组、阴性组孕妇TSH水平,并比较3组产科并发症(包括先兆子痫、妊高症、早产、胎儿宫内窘迫等)以及产后新生儿临床特征(身高、体重以及Apagar评分)和TSH指标。结果①在TPOAb阳性组孕妇中,有38.89%(28/72)存在亚临床甲减,TPOAb阴性组孕妇中有13.92%(28/158)存在亚临床甲减,两组相比差异有统计学意义(χ2=12.03,P<0.05);②3组间产科并发症差异有统计学意义(χ2=7.66,P<0.05);③3组产妇的新生儿临床特征差异均无统计学意义。而TPOAb阳性组产妇的新生儿TSH水平高于TPOAb阴性组,差异有统计学意义(P<0.05)。干预组和阴性组之间新生儿TSH水平差异无统计学意义。结论妊娠早期孕妇TPOAb阳性可能会对妊娠结局有一定影响,但对新生儿临床特征可能没有影响。对伴有亚临床甲减的TPOAb阳性孕妇早期干预治疗,可以改善不良妊娠结局。

Objective To explore the effects pregnancy and neonatal thyroid-stimulating hormone （TSH） levels on screening thyroid peroxidase antibody （TPOAb） and thyroid function in early pregnant women, and intervene the levels of TPOAb-positive pregnant women with subclir/ical hypothyroidism to levothyroxine （L-T4 ）. Methods 293 cases of TPOAb positive and negative euthyroid in early pregnant women were selected, which were divided into three groups： TPOAb-positive group, negative group and intervention group. We compared the incidence of obstetric comp]ications of three groups （ including pre-eclampsia, pregnancy-induced hypertension, preterm labor, fetal distress, etc. ） , post-neonatal clinical characteristics （height, weight and Apagar score） and the TSH levels. Results （1） In TPOAb-positive group, there were 38.89% （28/72） cases with subclinical hypothyroidism, it was 13.92% （28/158） in TPOAb-negative pregnant women, there was significant difference in two groups （X2 = 12.03, P 〈 0. 05 ） ; （2） Three groups were statistically significant difference in obstetric complications （X2 = 7.66, P 〈 0.05 ） ; （3） Three groups of newborns height, weight and Apagar score indicated no significant difference. The newborn TSH levels in TPOAb-positive group was higher than that in the TPOAb-negative group , the difference was statistically significant （P 〈 0.05 ）. Between the intervention group and negative group of neonatal, the TSH levels were no statistically significant. Conclusion TPOAb-positive pregnant women in early pregnancy may have some impact pregnancy outcomes, but the newborn clinical features may not be affected. It may improve pregnancy outcomes by early intervention in subclinical hypothyroidism with TPOAb-positive pregnant women .