重度子痫前期孕妇甲状腺功能变化及其与重度子痫前期发病的关系

Thyroid hormone changes in women with pre-eclampsia and its relationship with the presence of preeclampsia

目的 探讨重度子痫前期孕妇甲状腺激素水平变化、甲状腺疾病特点及其与重度子痫前期发病的关系.方法 选择2011年5月至2012年12月在中国医科大学附属盛京医院住院并分娩的重度子痫前期孕妇171例为重度子痫前期组,按发病孕周分为早发型114例和晚发型57例.随机抽取同期孕周和年龄与重度子痫前期组相匹配的血压正常、无产科合并症的健康孕妇171例为对照组.采用化学发光微粒免疫分析技术检测各组孕妇血清中促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）水平,采用化学发光法检测抗甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）水平,并计算其阳性率（TPOAb＞ 5.6 U/L为阳性,TGAb ＞4.1 U/L为阳性）.对重度子痫前期组孕妇血清TSH、FT3及FT4水平与血压的相关性进行分析.结果 （1）重度子痫前期组孕妇TSH中位水平为3.4 mU/L,FT4、FT3水平分别为（12.0±3.0）、（3.9 ±0.9） pmol/L;对照组分别为1.9 mU/L、（13.4±2.4）和（5.0±1.3） pmol/L,两组分别比较,差异均有统计学意义（P＜0.01）.其中早发型孕妇TSH中位水平为3.3 mU/L,FT4、FT3水平分别为（12.1±3.4）、（3.8±0.9）pmol/L;晚发型孕妇TSH中位水平为3.4 mU/L,FT4、FT3水平分别为（11.9±3.1）、（3.9±1.0）pmol/L,分别与对照组比较,差异有统计学意义（P＜0.01）；早发型与晚发型孕妇各指标分别比较,差异均无统计学意义（P＞0.05）.（2）重度子痫前期组孕妇TPOAb和TGAb阳性率分别为15.2％（26/171）和21.6％ （37/171）；对照组孕妇分别为12.3％ （21/171）和14.6％ （25/171）,两组孕妇TGAb阳性率比较,差异有统计学意义（P＜0.01）；TPOAb阳性率比较,差异无统计学意义（P＞0.05）.其中早发型孕妇TPOAb阳性率为12.3％ （14/114）,晚发型孕妇为21.1％ （12/57）,两者比较,差异无统计学意义（P＞0.05）；早发型孕妇TGAb阳性率为21.9％（25/114）,晚发型孕妇为21.1％（12/57）,两者比较,差异无统计学意义（P＞0.05）.晚发型与对照组TPOAb阳性率比较,差异有统计学意义（P＜0.01）.（3）重度子痫前期组及对照组孕妇甲状腺疾病患病率分别为47.4％（81/171）和16.4％ （28/171）,两组比较,差异有统计学意义（P＜0.01）.（4）重度子痫前期组及对照组孕妇亚临床甲状腺功能减退症（亚甲减）[或甲状腺功能减退症（甲减）]患病率分别为45.0％（77/171）和16.4％ （28/171）,两组比较,差异有统计学意义（P＜0.01）.（5）重度子痫前期组及对照组孕妇亚临床甲状腺功能亢进症（亚甲亢）患病率分别为2.3％ （4/171）和1.8％ （3/171）,两组比较,差异无统计学意义（P＞0.05）.（6）重度子痫前期组TSH水平为0.3～3.3 mU/L的孕妇,收缩压为（170 ±21）mmHg（1 mmHg =0.133 kPa）,舒张压为（112±15） mmHg;TSH水平＞3.3 mU/L的孕妇,收缩压为（166±21） mmHg,舒张压为（109±13） mmHg,两者比较,差异无统计学意义（P＞0.05）.其中早发型与晚发型孕妇舒张压比较,差异有统计学意义（P＜0.01）.重度子痫前期组孕妇血清TSH及FT4水平与收缩压及舒张压均无相关性（P＞0.05）,FT3与舒张压存在负相关性（r=-0.172,P=0.023）.结论 重度子痫前期孕妇常伴随甲状腺功能的改变,且以亚甲减多见,提示有必要对重度子痫前期孕妇行甲状腺激素水平及其抗体检查；重度子痫前期孕妇血清中FT4和FT3水平降低及TSH水平升高、TPOAb及TGAb阳性与重度子痫前期发生密切相关.

Objective To study thyroid hormone changes in women with pre-eclampsia patients,the characteristics of thyroid disease and its relationship with pre-eclampsia.Methods From May 2011 to December 2012 171 patients with pre-eclampsia who delivered in Shengjing Hospital of China Medical University were recruited as prc-eclampsia（PE） group,among which 114 cases were defined as early onset pre-eclampsia （EP） group and 57 cases were defined as late onset pre-eclampsia （LP） group.And 171 healthy women with same age and same stage of pregnancy were selected as the control group.Their blood pressures were normal and they had no obstetrical complications.Serum thyrotropin （TSH）,free triiodothyronine （FT3） and free thyroxine （FT4） levels were determined by solid-phase chemiluminescent enzyme immunoassay method （CMIA）.Thyroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TGAb） were measured by electro-chemiluminescent assay （ECLIA）.The positive rate was calculated （TPOAb ＞ 5.6 U/L,TGAb ＞ 4.1 U/L were defined as positive result）.The relationship between TSH,FT3,FT4 level and blood pressure was analyzed in women with pre-eclampsia.Results （1） The median values of TSH,FT4 and FT3 in PE group were 3.4 mU/L,（12.0 ± 3.0） pmol/L and（3.9 ± 0.9） pmol/L.In the control group,they were 1.9 mU/L,（13.4 ± 2.4） and （5.0 ± 1.3） pmol/L.There were statistically significant differences between the two groups（P ＜ 0.01）.In EP group,the median values of TSH,FT4 and FT3 were 3.3 mU/L,（12.1 ± 3.4） pmol/L and （3.8 ± 0.9） pmol/L.The differences between EP group and the control group were statistically significant （P ＜ 0.01）.In LP group,the median values of TSH,FT4 and FT3 were 3.4 mU/L,（11.9 ± 3.1） pmol/L and （3.9 ± 1.0） pmol/L.There were statistically significant differences compared to the control group（P ＜0.01）.While there was no difference between EP group and LP group （P ＞ 0.05）.（2） The positive rate of TPOAb and TGAb in PE group were 15.2％ （26/171）and 21.6％ （37/171）,and were 12.3％ （21/171） and 14.6％ （25/171） in the control group.There was statistically significant difference in the TGAb positive rate （P ＜ 0.01）,but the difference in TPOAb positive rate was not statistically different（P ＞0.05）.The TPOAb positive rates in EP group and LP group were 12.3 ％ （14/114） and 21.1％ （12/57）,respectively,with no statistically significant difference （P ＞ 0.05）.And the positive rates of TGAb in EP group and LP group were 21.9％ （25/114）and 21.1％ （12/57）,respectively,with no statistically significant difference（P ＞ 0.05）.The positive rate of TPOAb in LP group and in the control group had statistically significant difference（P ＜0.01）.（3） The morbidity of thyroid disease in PE group and in the control group were 47.4％ （81/171） and 16.4％ （28/171）,with statistically significant difference （P ＜ 0.01）.（4） The morbidity of subclinical hypothyroidism or hypothyroidism in PE group and in the control group were 45.0％ （77/171） and 16.4％ （28/171）,with statistically significant difference（P ＜0.01）.（5） The morbidity of subclinical hyperthyroidism in PE group and in the control group were 2.3 ％ （4/171） and 1.8 ％ （3/171）,with no statistically significant difference （P＞0.05）.（6） In PE group,women with TSH level of 0.3-3.3 mU/L had systolic pressure of（170 ± 21）mmHg （1mmHg =0.133 kPa）and diastolic pressure of（112 ± 15） mmHg; women with TSH ＞ 3.3 mU/L had systolic pressure of（166 ± 21）mmHg and diastolic pressure of（109 ± 13）mmHg.There was no statistically significant difference（P ＞ 0.05）.But the diastolic pressure in EP group and LP group had statistically significant difference（P ＜ 0.01）.In PE group,no correlation was found among TSH,FT4 levels and systolic pressure,diastolic pressure（P ＞ 0.05）.FT3 level was negatively correlated to diastolic pressure （r =-0.172,P =0.023）.Conclusions It is common that pre-eclampsia is complicated with thyroid dysfunction,mainly subclinical hypothyroidism.Thus it is nessesary to test thyroid hormone and thyroid antibodies in women with pre-eclampsia.The decrease of FT3 and FT4,the increase of TSH and the presence of TPOAb and TGAb are related with the presence of pre-eclampsia.