孕产妇甲状腺功能异常情况调查及管理模式研究

Investigation about thyroid dysfunction in pregnancy and its management exploration

目的了解余姚市孕产妇甲状腺功能异常发生情况。方法收集甲状腺功能异常的孕妇为研究组,随机抽取甲状腺功能正常的孕妇为对照组,同时研究组又分为孕期治疗组和观察组,均随访至产后42 d,分析各组间甲状腺疾病高危因素、孕产期合并症与并发症及异常妊娠结局的发生情况。结果余姚市孕产妇甲状腺功能异常发生率7.32%,甲状腺功能减退症、抗甲状腺过氧化物酶抗体(TPOAb)阳性甲减、TPOAb阴性甲减、甲状腺功能亢进症和TSH低值发生率分别是0.20%、1.66%、3.42%、1.26%、0.78%,研究组与对照组间甲状腺疾病(手术)史、有甲状腺功能异常症状及自然流产史/早产史/先天畸形史比较,差异有统计学意义(χ2分别=11.40、4.01、8.19,P均<0.05)。两组孕产期合并症、并发症发生情况比较,差异有统计学意义(χ2=8.94,P<0.05),两组妊娠结局情况比较,差异亦有统计学意义(χ2=6.65,P<0.05)。研究组中孕期治疗组与观察组妊娠结局情况比较,差异有统计学意义(χ2=8.51,P<0.05)。结论甲状腺功能异常是常见的孕期合并症,具有一定的高危因素,易致异常妊娠结局。

Objective To investigate the thyroid dysfunction situation of pregnancy in Yuyao. Methods The pregnancies with thyroid dysfunction were collected as the study group,and the pregnancies with normal thyroid function were randomly selected as the control group. The study group was divided into treatment group and observation group. They were all fol-lowed-up for 42 days, and their thyroid disease risk factors, maternal complications and abnormal pregnancy outcome were compared. Results The incidence of thyroid dysfunction of pregnancy in Yuyao was 7.32%. Hypothyroidism, hypothy-roidism of positive antithyroid peroxidase antibody （TPOAb）, hypothyroidism of negative TPOAb, hyperthyroidism and low level of TSH incidences were 0.20%, 1.66%, 3.42%, 1.26%, 0.78%respectively. The history of thyroid disease, symptom of thyroid dysfunction, the history of spontaneous abortion, preterm and congenital malformation between study group and control group were significantly different （χ2=11.40, 4.01, 8.19,P〈0.05）. The pregnancy complications and abnormal pregnancy outcomes were significantly different between two groups （χ2=8.94,6.65, P〈0.05）. The abnormal pregnancy outcome was significantly different between treatment group and observation group （χ2=8.51,P〈0.05）. Conclusion Thy-roid dysfunction is a common pregnancy complication with some risk factors, and it leads to abnormal pregnancy outcomes easily.