妊娠期母体血清甲状腺激素水平的动态变化及其与妊娠结局的关系

The relation between dynamic changes of maternal serum thyroid hormone levels during pregnancy and its pregnancy outcomes

目的探讨妊娠期母体血清甲状腺激素水平动态变化特征及其与妊娠结局间的关系。方法收集2012年1月-2013年12月,本院门诊及住院孕妇570例作为观察组,选择同期体检非妊娠期健康妇女120例作为对照组,采用化学发光分析仪检测对照组与观察组孕早期(84例)、孕中期(177例)和孕晚期(309例)的血清甲状腺激素水平;追踪随访观察组的妊娠结局。结果妊娠期母体血清T3、T4显著升高(P<0.05),FT3及FT4水平有降低趋势(P>0.05),TSH水平较非妊娠状态显著降低(P<0.05),以妊娠早期最低,此后呈增高的趋势;观察组SCH、TPOAb阳性和低T4血症发生率为7.89%、14.91%、7.72%;SCH与TPOAb阳性组不良妊娠结局发生率显著高于甲状腺功能正常组(P<0.05),而低T4血症组与甲状腺功能正常组差异无统计学意义(P>0.05)。结论妊娠期母体内血清甲状腺激素水平具有规律性变化,轻度甲减与不良妊娠结局密切相关,动态监测妊娠期血清甲状腺激素水平变化,对于及时筛查母体甲状腺功能异常及妊娠结局预测具有重要意义。

Objective To investigate the dynamic changes characteristics of maternal serum thyroid hormone levels during pregnancy and its relationship with pregnancy outcomes. Methods 570 cases of inpatient and outpatient pregnant women in our hospital between January 2012 and 2013 December were collected as the observation group,120 cases of non- pregnant healthy women in the same period for health examination were collected as the control group,the serum thyroid hormone levels of pregnant women were detected by chemiluminescence analyzer respectively in control group and trimester（ 84 cases）,the second trimester（ 177 cases） and the third trimester（ 309 cases） in observation group,and the pregnancy outcomes of the observation group were followed up. Results The T3,T4 levels of maternal serum during pregnancy were significantly higher（ P〈0. 05）.Levels of FT3 and FT4tended to decrease（ P 〉0. 05）,and the TSH level was significantly decreased than non- pregnant state（ P〈0. 05）,the lowest TSH level was in early pregnancy,since then showed an increasing trend; The incidence rates of SCH,TPOAb positive and Low T4 hyperlipidemia of the observation group were respectively 7. 89%,14. 91% and 7. 72%; The incidence rates of adverse pregnancy outcomes in SCH and TPOAb positive group was significantly higher than that of the normal thyroid function group（ P〈0. 05）,while there was no significant statistical difference between groups with low T4 hyperlipidemia normal thyroid function（ P 〉0. 05）. Conclusion The serum thyroid hormone levels during pregnancy has regular changes,mild hypothyroidism is closely related to adverse pregnancy outcomes. Dynamic monitoring of serum thyroid hormone levels in pregnancy has important significance for timely screening of maternal thyroid dysfunction and the predicting of pregnancy outcomes.