慢性HBV感染者孕早期促甲状腺激素水平对妊娠结局的影响

Effects of TSH levels in the first trimester of pregnancy on the pregnant outcomes of women with chronic HBV infection

目的探讨肝功能正常的慢性HBV感染者孕早期促甲状腺激素（thyroid stimulating hormone,TSH）水平对妊娠结局的影响。方法选择2010年7月至2015年4月在本院进行规律产前检查的2880例孕妇,其中1620例肝功能正常的慢性HBV感染者为H组,1260例非HBV感染者为NH组,根据孕8周前首次TSH水平将两组再分别分为亢进组（TSH2.5 m IU/L）、正常A组（NA组,2.0 m IU/L〈TSH≤2.5 m IU/L）和正常B组（NB组,0.1 m IU/L≤TSH≤2.0 m IU/L）。回顾性分析孕早期TSH水平对妊娠结局的影响。结果 H组、H-减退组、H-NA组和H-NB组的TSH水平均分别低于NH组、NH-减退组、NH-NA组和NH-NB组（P均〈0.05）,H-亢进组与NH-亢进组的TSH水平差异无统计学意义（t=1.786,P=0.067）。H组、H-亢进组、H-减退组、H-NA组和H-NB组的不良妊娠结局评分均分别高于NH组、NH-亢进组、NH-减退组、NH-NA组和NH-NB组（t值分别为4.046、2.081、4.904、2.133和3.429,P值分别为0.043、0.023、0.042、0.032和0.027）。H-亢进组、H-减退组、H-NA组的不良妊娠结局评分均高于H-NB组（t值分别为3.139、3.688和4.033,P值分别为0.033、0.031和0.028）。NH-NA组与NH-NB组的不良妊娠结局评分差异无统计学意义（t=1.885,P=0.067）。结论孕早期TSH水平异常对HBV感染孕妇妊娠结局的不良影响高于非HBV感染孕妇,TSH在0.1-2.0 m IU/L的慢性HBV感染孕妇不良妊娠结局最少,而TSH在2.0-2.5 m IU/L的慢性HBV感染孕妇不良妊娠结局较高,HBV感染孕妇孕早期TSH的正常参考值范围及其控制的合理水平可能低于非HBV感染孕妇。

Objective To investigate the effects of thyroid stimulating hormone（TSH） levels in the first trimester of pregnancy on the pregnant outcomes of women with chronic HBV infection. Methods Total of 2880 pregnant women who received regular antenatal examination from July 2010 to April 2015 in our hospital were selected and divided into two groups. There were 1620 chronic HBV infected pregnant women with normal liver function in the HBV infection group（H group） and 1260 pregnant women without chronic HBV infection in the non-HBV infection group（NH group）. Four subgroups were divided according to the levels of TSH in the first trimester of pregnancy（most before eight weeks of pregnancy）, including hyperthyroidism group（TSH 0.1 m IU/L）, hypothyroidism group（TSH 2.5 m IU/L）, normal A group（NA group, 2.0 TSH ≤ 2.5 m IU/L） and normal B group（NB group, 0.1 m IU/L ≤ TSH ≤ 2.0 m IU/L）. The effects of TSH levels in first trimester of pregnancy on the pregnant outcomes were analyzed retrospectively. Results The levels of TSH in H group, H-hypothyroidism group, H-NA group and H-NB group were significantly lower than those in NH group, NH-hypothyroidism group, NH-NA group and NH-NB group, respectively（P〈0.05）. The difference of TSH levels between the H-hyperthyroidism group and NH-hyperthyroidism group had no statistical significance（t = 1.786, P = 0.067）. The scores of poor pregnant outcomes in H group, H-hyperthyroidism group, H-hypothyroidism group, H-NA group and H-NB group were significantly higher than those in NH group, NHhyperthyroidism group, NH-hypothyroidism group, NH-NA group and NH-NB group, respectively（t = 4.046, 2.081, 4.904, 2.133, 3.429; P = 0.043, 0.023, 0.042, 0.032, 0.027）. The scores of poor pregnant outcomes in H-hyperthyroidism group, H-hypothyroidism group and H-NA group were significantly higher than that in H-NB group（t = 3.139, 3.688, 4.033; P = 0.033, 0.031, 0.028） and the difference between NH-NA group and NH-NB group had no statistical significance（t = 1.885, P = 0.067）. Conclusions The abnormal level of TSH in the first trimester of pregnancy in women with chronic HBV infection induced worse pregnant outcomes than women without chronic HBV infection. Chronic HBV infected women with TSH levels between 0.1 m IU/L and 2.0 m IU/L had satisfactory pregnant outcomes but those who with TSH levels between 2.0 m IU/L and 2.5 m IU/L had more poor pregnant outcomes. The reasonable level of TSH in the first trimester of pregnancy of women with chronic HBV infection may probably be different from normal pregnant women.