妊娠期甲状腺超声改变与甲状腺功能关系的研究

The relationship between thyroid ultrasonic parameters of pregnant women and thyroid function

目的探讨妊娠期甲状腺超声参数变化与甲状腺功能的关系。方法采用前瞻性设计，于2015年12月至2016年12月，以哈尔滨医科大学第四附属医院产科门诊常规备孕的健康育龄妇女为观察对象，采用自身对照方法，于孕前期、孕早期、孕中期、孕晚期进行甲状腺超声检查，测量4个时期甲状腺容积、甲状腺上动脉收缩期血流速度（PSV）及阻力指数（RI）；同时，在4个时期抽取静脉血，采用电化学发光免疫法检验血清游离三碘甲状腺原氨酸（n）、游离甲状腺素（甩）、促甲状腺激素（TSH）水平，分析甲状腺超声参数变化与甲状腺功能的关系。结果共选取备孕育龄妇女202例，剔除不符合纳入标准22例，其中169例成功受孕。甲状腺容积（cm3）孕前期（8．10±1．41）、孕早期（11．16±4．07）、孕中期（10．31±2．59）、孕晚期（9．98±2．02）比较差异有统计学意义（F=4．77，P〈0．01）；其中孕早期和孕中期与孕前期，孕中期和孕晚期与孕早期比较，差异有统计学意义（P均〈0．05）。左侧、右侧PSV（cm／s）孕前期（13．63±l_58、14．12±1．92）、孕早期（16．12±2．58、15．93±3．45）、孕中期（14．54±2．86、14．61±3．23）、孕晚期（13．23±2．85、13．54±2．13）比较差异均有统计学意义（F=2．95、2．41，P均〈0．05）：其中孕早期与孕前期和孕晚期、孕晚期与孕中期比较，差异有统计学意义（P均〈0．05）。FT3、FT4、TSH组间比较差异有统计学意义（x2=41．46、25．09、9．29，P〈0．01或〈0．05）。其中FT3（中位数，pmol／L）孕早期（4．85）与孕前期（3．84）、孕中期（4．41）、孕晚期（4．08）比较，差异有统计学意义（P均〈0．05）；n（pmol／L）孕早期（16．08）与孕前期（13．42）、孕中期（14．40）和孕晚期（12．80），孕前期与孕中期比较，差异有统计学意义（P均〈0．05）；TSH（mU／L）孕早期（1。05）与孕前期（1．65）和孕晚期（1．72）比较，差异有统计学意义（P均〈0．05）。甲状腺容积、PSV、RI参数变化与甲状腺功能FT3、FT4、TSH无明显相关关系（r均〈0．3，P均〉0．05）。结论妊娠可导致孕妇甲状腺超声参数和甲状腺功能发生变化，但二者之间无相关关系。

Objective To investigate the relationship between changes in thyroid ultrasound parameters and thyroid function during pregnancy. Methods With prospective design, from December 2015 to December 2016, healthy women at childbearing age at the Obstetrics Clinic of the Fourth Affiliated Hospital of Harbin Medical Univemity were observed using a self-control method in pre-pregnancy, early pregnancy, mid-pregnancy and late pregnancy. Thyroid ultra-sonography was performed to measure thyroid volume, systolic blood flow velocity （PSV）, and resistance index （RI） during the four phases. At the same time, venous blood was drawn at the four stages and electrochemiluminescence iinmunoassay was performed. Serum free triiodothyronine （FT3）, free thyroxine （FT4）, and thyroid stimulating hormone （TSH） were examined to analyze the relationship between changes in thyroid ultrasound parameters and thyroid function. Results A total of two hundred and two pregnant women of childbearing age were selected, twenty-two of them were excluded based on inclusion criteria, one hundred and sixty-nine were successfully conceived. Thyroid volume （cm3） was significantly different （F = 4.77, P 〈 0.01） between pre-pregnancy （8.10 ± 1.41）, early pregnancy （11.16± 4.07）, mid-pregnancy （10.31 ± 2.59）, and late pregnancy （9.98 ± 2.02）. Among them, there were statistically significant differences （P 〈 0.05） between early pregnancy and mid-pregnancy comparedwith pre-pregnancy, mid-pregnancy and late pregnancy with early pregnancy. Left and right PSV （cm/s） were significantly different （F = 2.95, 2.41 ,P 〈 0.05） between pre-pregnancy （13.63 ± 1.58, 14.12 ± 1.92）, early pregnancy （16.12± 2.58, 15.93 ± 3.45）, mid- pregnancy （14.54 ± 2.86, 14.61 ± 3.23）, and late pregnancy （13.23± 2.85, 13.54 ± 2.13）. Among them, there were statistically significant differences （P 〈 0.05） between pre-pregnaney and late pregnancy compared with early pregnancy, mid-pregnancy with late pregnancy. The differences between FT3, FT4 and TSH groups were statistically significant （X2 = 41.46, 25.09, 9.29, P 〈 0.01 or 〈 0.05）. FY3 （pmol/L） was significantly different （P 〈 0.05） between pre-pregnancy （3.84） and mid-pregnancy （4.41） and late pregnancy （4.08） compared with early pregnancy （4.85）. FT4 （pmol/L） was significantly different （P 〈 0.05） between early pregnancy （16.08） compared with mid-pregnancy （14.40）, pre-pregnancy （13.42）and late pregnancy （12.80）, pre-pregnaney compared with mid-pregnancy. TSH （mU/L） was significantly different （P 〈 0.05） between early pregnancy. （1.05） compared with pre-pregnaney （1.65） and late pregnancy（1.72）. Thyroid volume, PSV and RI changes were not significantly associated with thyroid function FT3, FT4, and TSH （r 〈 0.3, P 〉 0.05）. Conclusion Pregnancy can lead to changes in thyroid ultrasound parameters and thyroid function in pregnant women, but there is no correlation between them.