不同TSH标准诊断的妊娠早期亚甲减及TPO-Ab阳性对妊娠的影响分析

Analysis of different TSH criteria for the diagnosis of early pregnancy of subclinical hypothyroidism and the effect of TPO-Ab positive on pregnancy

目的:探讨不同促甲状腺激素(TSH)标准诊断的妊娠早期亚临床型甲状腺功能减退(亚甲减)及甲状腺过氧化物酶抗体(TPO-Ab)阳性对妊娠的影响。方法:选取我院产科孕早期开始行产前检查至结束妊娠的孕妇1 025例,在不同的TSH诊断标准(A标准TSH>2.5 mU·L^(-1)、B标准TSH>5.76 mU·L^(-1))下不同TPO-Ab检测结果患者的亚甲减发生率、妊娠并发症和妊娠不良结局发生率以及胎儿不良结局发生率的差异。结果:研究对象TPO-Ab阳性率为12.29%;按A标准,TPO-Ab阳性者亚甲减发生率高于TPO-Ab阴性者(P<0.05);按B标准,TPO-Ab阳性者亚甲减发生率也高于TPO-Ab阴性者(P<0.05)。妊娠并发症和妊娠不良结局发生率按A标准者低于按B标准者(P<0.05),且按B标准TPO-Ab阳性者高于TPO-Ab阴性者(P<0.05)。胎儿不良结局发生率按A标准者低于按B标准者(P<0.05),且按A标准TPO-Ab阳性者高于TPO-Ab阴性者,按B标准TPO-Ab阳性者也高于TPO-Ab阴性者,差异均有统计学意义(P<0.05)。结论:TSH和TPO-Ab是预测甲状腺功能异常和妊娠不良结局的重要临床指标,目前国际惯用TSH>2.5 mU·L^(-1)为亚甲减的诊断标准,其更利于预测甲状腺功能异常和妊娠不良结局的发生。

Objective： To investigate different thyroid hormone（ TSH） criteria for the diagnosis of early pregnancy of subclinical hypothyroidism and effect of thyroid peroxidase antibody（ TPO-Ab） positive on pregnancy.Methods：One thousand and twenty-five cases of pregnant women receiving prenatal examination in our hospital from early pregnancy to the full term were enrolled in this study.The incidences of subclinical hypothyroidism,pregnancy complications and adverse outcomes and fetal adverse outcomes of different TPO-Ab detections under different diagnostic criteria（ A standard TSH 〉 2.5 mU·L-1,B standard TSH 〉 5.76 mU·L-1） were compared.Results：TPO-Ab positive rate in all the subjects was 12.29%.According to standard A,the incidence of subclinical hypothyroidism in patients with TPO-Ab positive was higher than that in those with TPO-Ab negative（ P 〈 0.05）,so was that according to standard B（ P 〈 0.05）.According to standard A,the prevalence of pregnancy complications and adverse pregnancy outcome was lower than that of the B standard（ P 〈 0.05）,and according to standard B,there were more TPO-Ab positive patients than TPO-Ab negative ones（ P 〈 0.05）.The incidence of adverse pregnancy outcomes was lower by standard A than that by standard B（ P 〈 0.05）.By standard A there were more TPO-Ab positive patients than TPO-Ab negative ones,so was that according to the standard B,the difference being statistically significant（ P 〈 0.05）.Conclusion： TSH and TPO-Ab are predictors of thyroid function abnormalities and important clinical indicators of adverse outcomes of pregnancy.The current international diagnostic criterion for subclinical hypothyroidism is TSH 〉 2.5 mU·L-1,which is more conducive to predicting the occurrence of thyroid dysfunction and adverse pregnancy outcomes.