甲状腺过氧化物酶抗体阳性与妊娠事件的关系研究

Association between Thyroid Peroxidase Antibody Positivity and Pregnancy Event

目的回顾分析妊娠期甲状腺过氧化物酶抗体(TPOAb)阳性对妊娠事件的影响。方法选取2012年12月—2013年12月于首都医科大学附属北京世纪坛医院收治的初次妊娠并单胎孕妇2 048例为研究对象。妊娠6周时进行口服葡萄糖耐量试验(OGTT),检测服糖后2 h血糖水平;取空腹静脉血,检测空腹血糖、谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Cr)、TPOAb、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)和甲状腺素受体抗体(TRAb)水平。TPOAb阳性的甲状腺功能减退和亚临床甲状腺功能减退孕妇,以及TPOAb阴性的甲状腺功能减退孕妇给予每日空腹口服左甲状腺素片剂治疗,并根据TSH水平逐步调整用量。记录孕妇妊娠事件的发生情况,包括流产、妊娠期高血压疾病、贫血、妊娠期糖尿病、胎儿生长受限、早产及产后出血。结果 TPOAb阳性孕妇189例,阳性率为9.2%。TPOAb阳性与阴性孕妇FT3、FT4、TSH、TRAb水平比较,差异均有统计学意义(P<0.05)。TPOAb阳性孕妇甲状腺功能减退、亚临床甲状腺功能减退、低甲状腺素(T4)血症发生率高于TPOAb阴性孕妇(P<0.05)。TPOAb阳性与阴性孕妇贫血、胎儿生长受限、早产、产后出血发生率比较,差异均无统计学意义(P>0.05)。TPOAb阳性孕妇流产、妊娠期高血压疾病、妊娠期糖尿病发生率高于TPOAb阴性孕妇(P<0.05)。结论妊娠期TPOAb阳性孕妇甲状腺功能减退、亚临床甲状腺功能减退、低T4血症发生率升高,流产、妊娠期高血压疾病、妊娠期糖尿病的发生风险增加。

Objective To retrospectively analyze the impact of anti-thyroid peroxidase antibody（ TPOAb） positivity on pregnancy event. Methods A total of 2 048 women of first pregnancy with singleton in Beijing Shijitan Hospital,Capital Medical University from December 2012 to December 2013 were included. The pregnant women were conducted OGTT at the sixth week of gestation,and level of blood glucose was detected 2 hours after OGTT. And fasting venous blood sampling were assayed for fasting glucose,ALT,AST,BUN,Cr,TPOAb,FT3,FT4,TSH,and TRAb. The patients of TPOAb positive hypothyroidism and subclinical hypothyroidism, and TPOAb negative hypothyroidism were daily given oral thyroxine tablet treatment with empty stomach. Then the dosage was adjusted according to the TSH level gradually. The events of the pregnancy,including abortion, hypertensive disorder complicating pregnancy, anemia, gestational diabetes, fetal growth restriction,premature birth,and postpartum hemorrhage were recorded. Results 189 cases,9. 2% of the subjects were TPOAb positive.There were statistically significant differences in FT3,FT4,TSH,and TRAb levels between TPOAb positive and negative pregnant women（ P〈0. 05）. The incidence of hypothyroidism, subclinical hypothyroidism, and hypothyroxinemia were significantly higher in TPOAb positive pregnant women than those in TPOAb negative pregnant women（ P〈0. 05）. No statistically significant differences in incidence of anemia,fetal growth restriction,premature birth and postpartum hemorrhage between TPOAb positive and negative pregnant women（ P〉0. 05）. The incidence of abortion, hypertensive disordercomplicating pregnancy, gestational diabetes were higher in TPOAb positive pregnant women than those in TPOAb negative pregnant women（ P〈0. 05）. Conclusion TPOAb positive pregnant women have a higher incidence of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia. TPOAb positivity in pregnancy increase the risk of abortion,hypertensive disorder complicating pregnancy,gestational diabetes.