妊娠不同时期甲亢患者血清甲状腺功能及免疫功能水平检测的意义

Detection of serum thyroid function and immune function in patients with hyperthyroidism in different pregnancy periods

目的探讨妊娠不同时期甲亢患者血清甲状腺功能及免疫功能水平检测的意义。方法选择2015年3月至2017年3月在中山市博爱医院接受诊治的114例妊娠期甲亢患者的临床资料(观察组),根据确诊时间分为早孕期甲亢(51例)、中孕期甲亢(35例)、晚孕期甲亢(28例),另外选取同期在中山市博爱医院产检的114例妊娠期非甲亢者为对照组,比较观察组和对照组患者妊娠不同时期血清甲状腺功能及免疫水平的变化情况。结果早孕期甲亢组TT3、TT4显著高于对照组(t值分别为9.921、8.779,均P<0.05),TRAb阳性率显著低于对照组(χ2=19.024,P<0.05),而TSH、FT3、FT4均无显著性差异(t值分别为0.961、1.257、0.421,均P>0.05)。中孕期甲亢组TT3、TT4显著高于对照组(t值分别为6.123、11.902,均P<0.05),而TSH、FT3、FT4均无显著性差异(t值分别为1.831、1.198、0.698,均P<0.05),且TRAb阳性率无显著性差异(χ2=1.529,P>0.05)。晚孕期甲亢组TT3、TT4显著高于对照组(t值分别为6.174、9.413,均P<0.05),而FT3、FT4显著低于对照组(t值分别为6.738、3.764,均P<0.05),TSH两组比较无显著性差异(t=1.667,P>0.05),TRAb阳性率亦无显著性差异(χ2=0.107,P>0.05)。结论妊娠期甲亢患者血清TT3、TT4水平升高,妊娠前期TRAb阳性率较高,妊娠后期FT3、FT4降低,临床医生需注意妊娠不同时期甲状腺功能变化,以指导用药。

Objective To explore the value of detecting serum thyroid function and immune function in patients with hyperthyroidism in different pregnancy periods. Methods Clinical data of 114 patients with hyperthyroidism in pregnancy receiving treatment in Fengcheng Hospital Affiliated to the Ninth People＇s Hospital Affiliated to Shanghai Jiaotong University Medical School from March 2013 to March 2017 was retrospectively analyzed（ observe group）. The cases were divided into early pregnancy hyperthyroidism group（ 51 cases）,midpregnancy hyperthyroidism group（35 cases） and late pregnancy hyperthyroidism group（28 cases） according to diagnostic time. Another114 pregnant women without hyperthyroidism were chosen as control group at the same time in the hospital for this research. The levels of serum thyroid function and immune function were compared between two groups in different periods. Results In early pregnancy hyperthyroidism group,the serum total triiodothyronine（ TT3） and total thyroxine（ TT4） level were significantly higher than those in the control group（ t value was 9. 921 and 8. 779,respectively,both P〈 0. 05）,but the TRAb positive rate was significantly lower compared with the control group（ χ2 = 19. 024,P〈 0. 05）. There was no significant difference in serum TSH,free total triiodothyronine（ FT3） and FT4 between two groups（ t value was 0. 961,1. 257 and 0. 421,respectively,all P〈 0. 05）. In mid-pregnancy hyperthyroidism group,the serum TT3 and TT4 levels were significantly higher compared with the control group（ t value was 6. 123 and 11. 902,respectively,both P〈 0. 05）,but there was no significant difference in serum TSH,FT3 and FT4 between two groups（ t value was 1. 831,1. 198 and0. 698,respectively,all P〈 0. 05）. There was no significant difference in TRAb positive rate between two groups（ χ~2 = 2. 475,P 0. 05）. In late pregnancy hyperthyroidism group,the serum TT3 and TT4 levels were significantly higher compared with the control group（t value was 6. 174 and 9. 413,respectively,both P〈 0. 05）,but the serum FT3 and FT4 were significantly lower compared with control group（ t value was 6. 738 and 3. 764,respectively,both P〈 0. 05）. There was no significant difference in TSH between two groups（ t =1. 667,P〈 0. 05）,and the difference in TRAb positive rate was not significant between two groups（ χ~2 = 0. 107,P〈 0. 05）. Conclusion Patients with hyperthyroidism during pregnancy have elevated levels of serum TT3 and TT4. In early pregnancy TRAb positive rate is higher,and in late pregnancy FT3 and FT4 reduce. Clinicians need to pay attention to the gestational thyroid function changes during different periods to guide drug use.