不同严重程度HDCP患者孕晚期甲状腺功能水平的差异

Serum TSH,FT4 and TPO-Ab level difference in patients with hypertensive disorder complicating pregnancy of different severity in late pregnancy

目的探讨不同严重程度妊娠期高血压疾病(HDCP)患者孕晚期血清促甲状腺激素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPO-Ab)水平差异。方法于2014年9月至2016年10月在国家电网公司北京电力医院妇产科随机选取120例HDCP患者作为实验组,按照病情严重程度不同将其分为妊娠高血压组(45例)、轻度子痫前期组(40例)及重度子痫前期组(35例);并以同期于本院产检的113例健康孕妇为对照组。对比分析各组孕妇孕晚期的血清TSH、FT4和TPOAb水平。结果实验组的TSH及TPO-Ab水平明显高于对照组,而FT4水平显著低于对照组,差异具有统计学意义(t=4.258~8.768,均P<0.05),随着HDCP患者病情的加重,血清TSH水平明显呈升高的趋势(F=50.21,P<0.05),FT4水平则明显呈下降的趋势(F=28.97,P<0.05)。妊娠高血压组、轻度子痫前期组及重度子痫前期组的甲状腺功能异常发生疾病率依次增高,分别为2.22%、15.01%和48.64%;对照组的甲状腺功能异常发生疾病率为8.0%,与实验组相比差异均有统计学意义(χ~2=6.934,P<0.05),且妊娠高血压组、轻度子痫前期组及重度子痫前期组的甲状腺功能异常疾病发生率依次增高,差异具有统计学意义(χ~2值分别为4.575、24.254、9.859,均P<0.05)。结论随着HDCP患者病情的加重,其孕晚期的血清TSH水平明显越高,FT4水平明显越低,甲状腺功能异常疾病发生率显著增高。

Objective To observe the serum thyroid stimulating hormone（ TSH）,free thyroxine（ FT4） and thyroid peroxidase antibody（ TPO-Ab） level differences in patients with hypertensive disorder complicating pregnancy（ HDCP） of different severity in late pregnancy.Methods Altogether 120 patients with HDCP were randomly selected as experimental group in Beijing Electric Power Hospital of State Grid Corporation from September 2014 to October 2016. According to severity of disease,the cases in the experimental group were divided into pregnancy hypertension group（ n = 45）,mild preeclampsia group（ n = 40） and severe preeclampsia group（ n = 35）. At the same period,113 healthy pregnant women receiving antenatal check in the same hospital were randomly selected as control group. Levels of serum TSH,FT4 and TPO-Ab in late pregnancy were compared and analyzed in pregnant women in each group. Results Levels of TSH and TPO-Ab in the experimental group were significantly higher than those in the control group,while FT4 level was greatly lower in the experimental group with significant differences（ t value ranged 4. 258-8. 768,all P 0. 05）. With severity of HDCP increasing,serum TSH showed obvious rising trend（ F = 50. 21,P 0. 05）,while FT4 had significant decreasing trend（ F = 28. 97,P 0. 05）. Incidence rate of thyroid dysfunction in pregnancy hypertension group,mild preeclampsia group and severe preeclampsia group increased in turn,which was2. 22%,15. 01% and 48. 64%,respectively. While incidence of thyroid dysfunction in the control group was 8. 0%,which was significantly different from that in every experimental group（ χ~2 = 6. 934,P 0. 05）. Incidence rate of thyroid dysfunction in pregnancy hypertension group,mild preeclampsia group and severe preeclampsia group increased in turn,and difference had statistical significance（ χ~2 value was 4. 575,24. 254 and 9. 859,respectively,all P 0. 05）. Conclusion When HDCP becomes more severe,serum TSH in late pregnancy is significantly higher but FT4 is significantly lower,and incidence of thyroid dysfunction increases significantly.