席汉综合征患者甲状腺激素水平研究

The research for levels of thyroid hormone in patients with Sheehan′s syndrome

目的研究席汉综合征患者的甲状腺激素水平状况。方法比较纳入研究的100例席汉综合征患者与100例女性健康对照者促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）水平差异;比较席汉综合征患者治疗前后TSH、fT3、fT4水平变化;比较不同发病时间席汉综合征患者TSH、fT3、fT4水平差异。结果席汉综合征患者与健康对照者比较,TSH水平分别为1.60（0.79-2.86）、3.08（1.97-5.08）mU/L;fT3水平分别为2.09（1.44-3.69）、4.86（4.49-5.40）pmol/L;fT4水平分别为8.01（3.45-12.64）、14.56（13.63-16.11）pmol/L（P值均小于0.001）;席汉综合征患者治疗后TSH、fT3、fT4水平分别为1.16（0.57-2.11）mU/L、3.27（2.38-4.11）pmol/L、14.32（10.48-15.92）pmol/L,3指标与治疗前比较,差异有统计学意义（P值均小于0.05）;根据分娩大失血到发病时间不同分为小于1年、1-5年以及大于5年3组,TSH水平分别为2.85（2.21-3.51）、1.82（1.24-2.98）、1.52（0.65-2.64）mU/L,P〈0.05;fT3水平分别为3.74（2.24-4.45）、2.54（1.87-3.32）、1.89（1.13-3.11）pmol/L,P〈0.05;fT4水平分别为12.21（10.45-14.32）、8.52（5.13-12.34）、7.85（3.12-10.12）pmol/L,P〈0.05。结论 TSH可作为席汉综合征与原发性甲减一项鉴别指标;分娩大出血到发病时间越长,垂体前叶功能减退越明显;席汉综合征患者治疗过程中应定期监测甲状腺激素,防止甲亢的发生;对于产后大出血患者,应该早期监测甲状腺激素等并结合临床表现,及早诊断及时治疗,防止席汉综合征及其危象发生。

Objective To research the levels of thyroid hormone in patients with Sheehan′s syndrome.Methods The difference of thyroid-stimulating hormone（TSH）or free triiodothyronine（fT3）or free thyroxine（fT4）levels was compared between 100 patients with sheehan′s syndrome and 100 cases of female healthy controls included in this study.The difference for TSH or fT3 or fT4levels was compared between before and after treatment in Sheehan′s syndrome patients.The difference of TSH or fT3 or fT4levels was compared when time from a large bleeding to disease onset below 1year,1-5years and over 5years respectively in Sheehan′s syndrome patients.Results The difference of TSH or fT3 or fT4levels between patients with Sheehan′s syndrome and female healthy controls had obvious statistical significance.TSH：1.60（0.79-2.86）mU/L versus 3.08（1.97-5.08）mU/L,fT3：2.09（1.44-3.69）pmol/L versus 4.86（4.49-5.40）pmol/L,fT4：8.01（3.45-12.64）pmol/L versus 14.56（13.63-16.11）pmol/L（P〈0.001 for comparisons respectively）.The difference of TSH or fT3 or fT4levels between before and after treatment had obvious statistical significance.TSH：1.60（0.79-2.86）mU/L versus 1.16（0.57-2.11）mU/L,fT3：2.09（1.44-3.69）pmol/L versus3.27（2.38-4.11）pmol/L,fT4：8.01（3.45-12.64）pmol/L versus 14.32（10.48-15.92）pmol/L（P〈0.05 for comparisons respectively）.Time from a large bleeding to disease onset were below 1year,1-5years and over 5years,TSH levels were respectively 2.85（2.21-3.51）、1.82（1.24-2.98）and 1.52（0.65-2.64）mU/L（P〈0.05 for comparisons）.The fT3 levels were respectively 3.74（2.24-4.45）,2.54（1.87-3.32）and 1.89（1.13-3.11）pmol/L（P〈0.05 for comparisons）.The fT4 levels were respectively 12.21（10.45-14.32）,8.52（5.13-12.34）and 7.85（3.12-10.12）pmol/L（P〈0.05 for comparisons）.Conclusion TSH could serve as an identifiable index for sheehan′s syndrome and primary hypothyroidism.The time from a large bleeding to the disease onset is longer,the anterior pituitary function is more serious.Thyroid hormone should be monitored regularly in order to prevent the happening of hyperthyroidism during the process of the treatment.For postpartum hemorrhage patients,thyroid hormone should be early detected and combine with the clinical manifestations.They should early diagnose and timely treat in order to prevent the sheehan′s syndrome and its crisis.