甲状腺过氧化物酶抗体阳性孕妇妊娠结局及临床干预意义分析

Analysis of pregnancy outcomes of pregnant women with positive thyroid peroxidase antibody and significance of clinical intervention

目的 探讨甲状腺过氧化物酶抗体（TPOAb）阳性孕妇妊娠结局及进行临床干预的必要性.方法 选取2012年6月至2014年6月于上海交通大学医学院附属国际和平妇幼保健院就诊并定期随访的单纯TPOAb阳性孕妇122例.根据是否给予左甲状腺素钠片将孕妇分为单纯TPOAb阳性组（87例）;左甲状腺素钠片干预组（35例）,发现促甲状腺素升高后及时给予左甲状腺素钠片治疗;另外选择同期分娩的健康孕妇85名作为健康对照组.妊娠期定期随访和评价甲状腺功能,比较3组孕妇妊娠期并发症及结局.结果 单纯TPOAb阳性组和左甲状腺素钠片干预组与健康对照组比较,胎膜早破、羊水异常、胎儿窘迫发生率差异有统计学意义[25.3％ （22/87）、31.4％ （11/35）比10.6％ （9/85）,16.1％ （14/87）、20.0％（7/35）比5.9％ （5/85）,27.6％（24/87）、34.3％（12/35）比10.6％ （9/85）,P＜O.05],而妊娠期糖尿病、妊娠期高血压、早产发生率及有不良孕产史者占比差异无统计学意义（P＞0.05）.单纯TPOAb阳性组和左甲状腺素钠片干预组比较,上述各项指标差异均无统计学意义（P＞0.05）.结论 妊娠期TPOAb阳性与妊娠期胎膜早破、羊水异常及胎儿窘迫相关.给予左甲状腺素钠片干预后,妊娠期不良结局仍与单纯TPOAb阳性者相似.

Objective To analyze the pregnancy outcomes of women with positive thyroid peroxidase antibody （TPOAb） and discuss the necessity of clinical intervention.Methods Totally 122 pregnant women with positive TPOAb from June 2012 to June 2014 were enrolled and divided into pure positive TPOAb group （87 cases） with normal thyrotropin （TSH） and intervention group （85 cases） with increased TSH timely given levothyroxine sodium; in addition,85 healthy pregnant women were selected as control group.The thyroid function was followed up during gestation.The pregnancy complications and outcomes were compared among the three groups.Results The incidence of premature rupture of membranes,abnormal amniotic fluid and fetal distress in pure positive TPOAb group were significantly higher than those in intervention group and control group [25.3% （22/87）,31.4% （11/35） vs 10.6% （9/85）,16.1% （14/87）,20.0% （7/35） vs 5.9% （5/85）,27.6% （24/87）,34.3% （12/87） vs 10.6% （9/85）] （P 〈 0.05）.Gestational diabetes,gestational hypertension,abnormal gestation and birth,incidence of premature birth had no statistical differences among three groups.Above parameters were not significantly different between pure positive TPOAb group and intervention group （P 〉 0.05）.Conclusion Positive TPOAb during pregnancy is associated with premature rupture of membranes; levothyroxine sodium intervention for those with increased TSH can not improve the poor pregnancy outcomes,which is similar to those with pure positive TPOAb.