不同孕期孕妇甲状腺自身抗体与甲状腺功能的关系

Relationship between thyroid autoantibodies and thyroid function in pregnant women during different gestation period

目的探讨贵阳市观山湖区不同孕期孕妇特异性血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)水平变化及其与甲状腺功能状态的关系。方法选取2015年10月至2016年9月在观山湖区碧海和金华园两个社区卫生服务中心(本院创办)行孕期检查的常住该区健康单胎初产妇341例,采用电化学发光法检测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TPOAb、TgAb水平。结果 341例孕妇中妊娠甲状腺功能异常的患病率为13.20%,特异血清甲状腺自身抗体阳性率为12.61%,主要分布于孕早、中期。其中,妊娠临床甲状腺功能减退症(临床甲减)、亚临床甲减、低T4血症、临床甲状腺功能亢进症(临床甲亢)及亚临床甲亢的患病率分别为0.59%、7.92%、3.23%、0.88%及0.59%。妊娠血清TPOAb阳性率显著高于TgAb(10.85%vs.4.99%,P<0.01),甲状腺功能异常的TPOAb阳性率显著高于甲状腺功能正常的TPOAb阳性率(44.44%vs.5.74%,P<0.01)。孕早、中期TPOAb阳性孕妇TSH水平高于TPOAb阴性孕妇(P<0.05,P<0.01);甲状腺功能异常TPOAb阳性孕妇TSH水平较TPOAb阴性孕妇和甲状腺功能正常TPOAb阳性孕妇显著增高(均P<0.01)。孕早、中期TPOAb阳性孕妇甲状腺功能减退症的患病率(58.33%、46.15%)均显著高于TPOAb阴性孕妇(均P<0.01),尤其孕早期TPOAb阳性孕妇亚临床甲减、低T4血症、临床甲减的患病率(29.17%、20.83%、8.33%)均明显高于TPOAb阴性孕妇(均P<0.01)。结论妊娠期TPOAb和TgAb阳性与甲状腺功能异常相关,甲状腺自身抗体阳性对妊娠结局及子代发育造成不良影响,妊娠期TSH、FT3、FT4的检测并不能完全反应甲状腺功能状态,应在妊娠早、中期增加TPOAb和TgAb的筛查,加强对妊娠甲状腺自身抗体阳性者的监测,以利于妊娠甲状腺疾病的早期诊治。

Objective To investigate the changes of serum thyroid peroxidase （TPOAb） and thyroglobulin antibody （TGAb） and their relationship with thyroid function in pregnant women during different gestation period Methods Totally 341 cases of primiparae were selected from October 2015 to September 2016 and levels of serum thyrotropin （TSH）, free triiodothyronine （FT3）, free thyroxine （FT4）, thyroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TgAb） were measured by electrochemiluminescence. Results The prevalence of thyroid dysfunction and positive serum thyroid autoantibodies were 13.2% and 12.61% respectively, which mainly occurred in early and middle pregnancy. Thyroid dysfunction in subjects included hypothyroidism （0.59%）, subclinical hypothyroidism （7.92%） , low T4 hyperlipidemia （ 3.23% ） , hyperthyroidism （0.88%） and subclinical hyper- thyroidism （0.59%）. The positive rate of TPOAb was significantly higher than that of TgAb （10.85% vs. 4.99%, P 〈 0.01 ）. The positive rate of TPOAb in women with thyroid disfunction was significantly higher than that in those with normal thyroid function （44.44% vs. 5.74%, P 〈0.01 ）. TSH level of TPOAb positive subjects was higher than that of TPOAb negative ones （P 〈 0.05, P 〈 0.01 ） ; TSH level of TPOAb positive subjects with thyroid dysfunction were significantly higher than those of TPOAb negative subjects and TPOAb positive pregnant women but with norreal thyroid function （P 〈 0.01 ）. The hypothyroidism prevalence rate of TPOAb positive subjects was significantly higher than that of TPOAb negative subjects in early and middle stage of pregnancy （P 〈 0.01 ）. The prevalence rates of subclinical hypothyroidism, low T4 hyperlipidemia and clinical hypothyroidism were significantly higher in TPOAb positive pregnant women （29.17%, 20.83% and 8.33%） than those in TPOAb negative pregnant women （P 〈 0.01 ）. Conclusions Thyroid dysfunction is closely related to positive status of TPOAb and TgAb in pregnancy, which could influence the outcome of pregnancy and the development of offspring. Since levels of TSH, FT3 and FT4 could not fully reveal thyroid function, it is necessary to monitor the status of TPOAb and TgAb as early as possible for the early diagnosis and treatment of thyroid disease in pregnancy.