亚临床甲状腺功能减退及其抗体阳性对妊娠结局的影响

Influence of subclinical hypothyroidism and positive thyroid peroxidase antibody on pregnancy outcomes

目的明确亚临床甲状腺功能减退（SCH）及其过氧化物酶抗体（TPOAb）阳性对妊娠结局的影响。方法收集2014年1月至2015年8月在首都医科大学附属北京友谊医院妇产科产检的2 750例孕早期单活胎产妇病历资料,分为SCH＋TPOAb阳性组,SCH＋TPOAb阴性组,单纯TPOAb阳性组和对照组,比较分析4组孕妇妊娠结局和新生儿状况。结果与对照组相比,SCH＋TPOAb阳性组妊娠期糖尿病（GDM）、妊娠期高血压及临床甲状腺功能减退症、早产、自发性流产及足月低体重儿发生率均明显增加（χ~2值分别为12.07、4.17、433.89、9.95、8.28、5.78,均P〈0.05或P〈0.01）;SCH＋TPOAb阴性组临床甲状腺功能减退症,自发性流产发生率均明显增加（χ~2值分别为152.35、5.80,均P〈0.05或P〈0.01）;单纯TPOAb阳性组妊娠期高血压、SCH、临床甲状腺功能减退症、早产发生率均明显增加（χ~2值分别为7.23、38.55、39.73、8.96,均P〈0.01）;SCH＋TPOAb阳性组临床甲状腺功能减退症及早产发生率明显高于SCH＋TPOAb阴性组（χ~2值分别为10.23、5.16、均P〈0.05或P〈0.01）。四组非瘢痕子宫剖宫产、未足月胎膜早破（PPROM）、产后出血、子痫前期、胎儿窘迫、巨大儿、1分钟Apgar评分〈7分的发生率均无统计学差异（χ~2值分别为4.33、1.33、3.79,均P〉0.05）。结论甲状腺功能正常孕妇孕早期促甲状腺激素（TSH）水平升高和（或）TPOAb阳性可明显增加产妇妊娠并发症及新生儿不良结局的发生率,应定期筛查,及早干预。

Objective To explore the influence of subclinical hypothyroidism （SCH） and positive thyroid peroxidase antibody （TPOAb） on pregnancy outcomes. Methods A total of 2 750 women with early singleton live pregnancy were selected from January 2014 to August 2015 in Beijing Friendship Hospital, and they were divided into four groups ： SCH ＋ TPOAb （ ＋ ） group, SCH ＋ TPOAb （ - ） group, simple TPOAb（ ＋ ） group, and control group. The pregnancy outcomes of four groups were observed. Results Compared to the control group, the SCH ＋ TPOAb （ ＋ ） group had significantly higher incidences of gestational diabetes mellitus （ GDM ）, gestational hypertension, hypothyroidism, preterm delivery, spontaneous abortion and term low birth weight （X2 value was 12.07,4.17,433.89,9.95, 8.28 and 5.78, respectively, P 〈 0.05 or P 〈 0.01 ）. The SCH ＋ TPOAb （ - ） group had significantly higher incidences of hypothyroidism and spontaneous abortion （X2 value was 152.35 and 5.80, respectively, P 〈 0.05 or P 〈 0.01 ）. The simple TPOAb （ ＋ ） group had significantly higher incidences of gestational hypertension, SCH, hypothyroidism, and preterm delivery （X2 value was 7.23,38.55,39.73 and 8.96,respectively, all P 〈0.01 ） . The incidence of hypothyroidism and preterm delivery were higher in SCH ＋ TPOAb （ ＋ ） group than in SCH ＋ TPOAb （ - ） group （X2 value was 10.23 and 5.16, respectively, P 〈 0.05 or P 〈 0.01 ）. While the incidences of cesarean section, preterm premature rupture of membranes （PPROM）, postpartum hemorrhage, preeclampsia, fetal distress, fetal macrosomia and 1 min Apgar score 〈 7 points were not statistically different among four groups （ all P 〉 0.05 ）. Conclusion High thyroid - stimulating hormone （TSH） level and （or） TPOAb （ ＋ ） in pregnant women with normal thyroid could significantly increase the incidences of adverse pregnancy and birth outcomes. Regular screening and timelv intervention are suggested.