妊娠期亚临床甲减者TPOAb与妊娠结局相关性分析

Correlation analysis of TPOAb and pregnancy outcomes of patients with subclinical hypothyroidism

目的研究妊娠期亚临床甲减的甲状腺激素替代治疗与妊娠结局的相关性,并探究妊娠早期亚临床甲减中甲状腺过氧化物酶抗体(TPOAb)阳性与妊娠结局的关系。方法选取2012年10月至2014年10月在南京市第一医院产科常规产检并分娩单胎孕妇,根据孕晚期入院后TSH及FT4水平将其分为亚临床甲减治疗组(67例)、亚临床甲减未治疗组(38例),对其增加TPOAb检测,予同期产检甲状腺功能正常的孕妇中随机抽取99例作为对照组,比较妊娠结局。同时根据TPOAb检测结果及是否进行加甲状腺激素替代治疗分为TPOAb阳性治疗组、TPOAb阳性未治疗组、TPOAb阴性治疗组及TPOAb阴性未治疗组。结果亚临床甲减未治疗组、治疗组及对照组3纽在年龄、孕次及分娩孕周上无明显差别。未治疗组妊娠期贫血的发病率、胎儿宫内窘迫的发病率均高于治疗组(15.8%vs 3.0%,P=0.025;15.8%vs 4.5%,P=0.047),未治疗组妊娠期糖尿病发生率、早产发生率均高于对照组(29.0%vs 14.4%,P=0.024;13.1%vs 3.0%,P=0.045)。妊娠期高血压疾病、产后出血、胎膜早破、臀位的发生率在三组间无统计学差异,但未治疗组与对照纽相比其发生率均有一定增高,差异未见统计学意义,考虑与样本量相关,扩大样本量后进一步研究。对亚临床甲减孕妇均进行了抗体检查,TPOAb阳性率为43.8%,SCH孕妇TPOAb阳性者中未治疗组的妊娠期糖尿病、妊娠期高血压疾病发生率较治疗组明显增高且差异有统计学意义(61.5%vs25%,P=0.039;30.7%vs 6.25%,P=0.049),TPOAb阴性者中治疗组与未治疗组相比较,早产发生率有统计学意义(0%vs 20%,P=0.011)。结论妊娠期亚临床甲状腺功能减退可能与早产、妊娠期贫血、胎儿宫内窘迫、妊娠期糖尿病等妊娠不良结局相关,亚临床甲减合并TPOAb阳性可能与妊娠期高血压疾病、妊娠期糖尿病等不良妊娠结局相关,通过及时有效的甲状腺激素替代治疗可明显降低其发生率。妊娠早期应普查TSH及TPOAb等甲状腺功能,发现异常应积极进行干预,改善妊娠结局。

Objectve To study the correlation between thyroid hormones replacement therapy and pregnancy outcomes of patients with subclinical hypothyroidism （SCH） and the relationship between thyroid peroxidase antibody （TPOAb） positive and pregnancy outcomes. Methods The pregnant women with single birth who visited the obstetrics department of Nanjing Hospital Affiliated to Nanjing Medical University from October 2012 to October 2014 were selected in research group. According to TSH and FT4 levels, the cases were divided into three groups, SCH treatment group （67 cases） and SCH no treatment group （38 cases） undergoing TPOAb detection as well as control group （99 cases） with normal thyroid function to compare pregnancy outcomes. Based on TOPAb detection results and whether thyroid hormone replacement therapy was given, the cases were grouped into TPOAb positive treatment group, TPOAb positive no treatment group, TPOAb negative treatment group and TPOAb negative no treatment group. Results The differences in age, gravidity and gestational week at delivery were not significant among SCH no treatment group, treatment group and control group. In no treatment group, the incidence of anemia during pregnancy and fetal distress were significantly higher than in treatment group （ 15.8% vs 3.0% , P = 0. 025 ; 15.8% vs 4.5% , P =0. 047） , and that of gestational diabetes mellitus and preterm birth was higher than in the control group （29.0% vs 14.4% , P = 0. 024 ; 13.1% vs 3.0%, P = 0.045 ）. The incidence of gestational hypertension diseases, postpartum hemorrhage, premature rupture of membranes and breech presentation showed no significant difference among three groups, but it increased in the no treatment group compared to the control group without statistical significance. Considering the results correlated with samples, further studies were needed with larger samples. Antibody chemiluminescence immunoassay was conducted for all SCH patients, and the positive rate of TPOAb was 43.8%. For TPOAb positive cases in no treatment group, the incidences of gestational diabetes mellitus and gestational hypertensive diseases increased remarkably and they were significantly higher than the treatment group （61.5% vs 25%, P = 0. 039; 30.7% vs 6.25%, P = 0.049）. Among the cases with TPOAb negative, the premature birth rate was statistically different between treatment group and no treatment group （0% vs 20% , P = 0.011 ）. Conclusion Gestational SCH might be related to adverse pregnancy outcomes such as premature birth, anemia, fetal distress and gestational diabetes mellitus. Timely and effective thyroid hormone replacement therapy can reduce its incidence. TSH and TPOAb should be detected at early gestational stage, and active intervention should be taken if any abnormality found so as to improve adverse pregnancy outcomes.