妊娠期甲状腺功能减退孕妇甲状腺功能对子痫前期母婴预后的影响

Effect of thyroid function on maternal and infantile prognosis of pregnant women with preeclampsia and hypothyroidism

目的探讨妊娠期甲状腺功能减退(甲减)孕妇甲状腺功能对子痫前期(PE)母婴预后的影响,为临床防治措施提供参考依据。方法选择2014年1月-2016年1月在青岛市第九人民医院门诊住院分娩的PE孕妇230例,依据诊断标准分为轻度子痫前期(MPE)组67例、重度子痫前期(SPE)组163例,另选健康孕妇90例为对照组;采集静脉血检测血清促甲状腺激素(TSH)、游离甲状腺素3(FT_3)、FT_4、甲状腺自身抗体(TPOAb),并追踪随访收集妊娠结局及围产儿结局资料。结果SPE组患者甲减发生率9.82%和亚临床甲减发生率39.88%均显著高于MPE组和对照组,差异均有统计学意义(P<0.05);PE甲减组早产率75.25%和剖宫产率95.29%显著高于对照组,差异有统计学意义(P<0.05);PE甲减组胎儿出生体质量低于对照组,胎儿入住NICU发生率60.00%、1 min Apgar<8的发生率15.29%显著高于对照组,差异有统计学意义(P<0.05)。结论妊娠期甲减对于子痫前期的发生具有促进作用,妊娠期甲减合并子痫前期增加孕妇早产及流产的发生率,也会对围产儿的健康造成影响,需要在临床中及时发现尽早治疗,改善预后。

Objective To explore the effect of thyroid function on maternal and infantile prognosis of pregnant women with preeclampsia and hypothyroidism,provide a reference basis for clinical prevention and treatment. Methods From Janaury 2014 to January 2016,230 pregnant women with preeclampsia were selected from the Ninth People ＇s Hospital of Qingdao,then they were divided into mild preeclampsia group（ 67 pregnant women） and severe preeclampsia group（ 163 pregnant women） according to the diagnostic criteria; 90 healthy pregnant women were selected as control group. The venous blood samples were obtained to detect the levels of serum thyroid stimulating hormone（ TSH）,free triiodothyronine（ FT_3）,free thyroxine（ FT_4）,and thyroid autoantibody（ TPOAb）. Pregnancy and perinatal outcomes were followed up and collected. Results The incidence rates of hypothyroidism and subclinical hypothyroidism in severe preeclampsia group were 9. 82% and 39. 88%,respectively,which were statistically significantly higher than those in mild preeclampsia group and control group（ P〈0. 05）. The rates of premature birth and cesarean section in preeclampsia group were statistically significantly higher than those in control group（ P〈0. 05）. Neonatal birth weight in preeclampsia group was statistically significantly lower than that in control group（ P〈0. 05）.The admission rate of NICU and incidence rate of neonates with one-minute Apgar score 〈8 in preeclampsia group were 60. 00% and15. 29%,which were statistically significantly higher than those in control group（ P〈0. 05）. Conclusion Hypothyroidism during pregnancy can promote the occurrence of preeclampsia,hypothyroidism during pregnancy combined with preeclampsia can increase the incidence rates of premature delivery and abortion,which has impact on health of perinatal infants,early detection and early treatment are necessary to improve the prognosis.