女性妊娠期甲状腺功能减退与产后焦虑、抑郁情绪的关系

Relationship between hypothyroidism and postpartum anxiety and depression during pregnancy

目的探讨妊娠期甲状腺功能减退与产后焦虑、抑郁情绪的相关性及相关程度。方法随机选取2014年1月~2016年12月在我院高危门诊产检甲状腺功能减退的孕妇719例,同期正常孕妇548例,在产后1、3、6及12个月对两组孕妇随防,分别利用焦虑抑郁量表(HAD)、爱丁堡产后抑郁量表(EPDS)、产后抑郁筛查量表(PDSS)评估其焦虑、抑郁症状的发生率,并分析其与促甲状腺激素(TSH)、游离甲状腺素(FT4)抗甲状腺过氧化物酶抗体(TPO-Ab)、TPO-Ab水平的相关性。结果 (1)两组相比,产后焦虑、抑郁平均分比较,差异均有统计学意义(t=4.27,8.13,P=0.000,0.006);(2)产后焦虑症状发生率在产后6个月无统计学差异(χ~2=0.144,P=0.705),产后1、3、12个月均有统计学意义(χ~2=8.826、4.137、4.602,P=0.031、0.042、0.017)。产后抑郁的发生率在产后1、3、6个月比较,差异均有统计学意义(χ~2=20.145、62.921、25.341、P=0.043、0.008、0.036),产后12个月差异无统计学意义(χ~2=2.211,P=0.136);(3)产后EPDS评分与FT4水平呈负相关(r=-0.693,P=0.015),与TSH值水平呈正相关(r=0.366,P=0.004),与TPO-Ab是否阳性没有相关性(r=2.390,P=0.774)。结论产后焦虑、抑郁症状的发生与孕期甲状腺功能减退有相关性,应高度重视妊娠期甲状腺功能减退患者的孕期心理情绪疏导,产后严密随访。

Objective To investigate the correlation between hypothyroidism and postpartum anxiety and depression during pregnancy. Methods From January 2014 to December 2016, 719 pregnant women with hypothyroidism and 548 normal pregnant women were selected randomLy from high-risk clinics in our hospital from January 2014 to December 2016, The incidences of anxiety and depression were evaluated by anxiety and depression scale（HAD）, Edinburgh Postnatal Depression Scale （EPDS） and Postpartum Depression Screening Scale （PDSS） respectively, and their associa tion with thyroid stimulating hormone（TSH）, free Thyroid hormone（FT4） anti-thyroid peroxidase antibody（TPO-Ab）, TPO-Ab levels. Results （1） The average postpartum anxiety and depression scores between the two groups were statisti cally significant （t=4.27, 8.13, P=0.000, 0.006）.（2） The incidence of postpartum anxiety symptoms after 6 months was not significantly different（x2=0.144, P=0.705） while it was significantly different at postpartum 1,3 and 12 months（X2=8.826, 4.137, 4.602, P=0.031, 0.042, 0.017）. The incidence of postpartum depression in postpartum 1,3,6 months were statisti- cally significant（x2=20.145, 62.921, 25.341, P=0.043, 0.008, 0.036） while there was not statistically significant after 12 months（x2=2.211,/）=0.0136）. （3）There was a negative correlation between EPDS score and the level of FT4, There was a positive correlation between EPDS score and the level of TSFI（r=0.366, P=0.004）, which was not correlated with whether TPO-Ab was positive （r=2.390, P=0.744）. Conclusion Postpartum anxiety and depressive symptoms are correlated with hypothyroidism during pregnancy. Psychological and emotional counseling during pregnancy should be paid great attention to during pregnancy and closely followed up during postpartum period.