妊娠期甲减合并子痫前期的临床分析

Clinical analysis of hypothyroidism and preeclampsia during pregnancy

目的:分析妊娠期甲状腺功能减退症(以下简称"甲减")合并子痫前期(PE)的临床指标变化及二者的相关性.方法:选取医院2016年5月~2017年5月期间在我院进行孕产检的孕妇360例,根据是否合并甲减分为正常组(n=120)、亚临床甲减组(n=120)、临床甲减组(n=120).收集所有孕妇血压等临床资料,检测甲状腺功能指标、尿蛋白等指标,并统计两组孕妇PE发生情况.结果:正常组、亚临床甲减组、临床甲减组孕妇年龄、身高、孕前体重、孕周、孕次等基线资料比较无统计学意义;但其血清促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)依次明显升高,游离三碘甲状腺原氨酸(FT3)、甲减游离甲状腺素(FT4)依次明显降低,差异比较有统计学意义;且其收缩压、舒张压及尿蛋白依次明显升高,差异比较亦有统计学意义.妊娠期甲减孕妇TSH、TPOAb与收缩压、舒张压、尿蛋白呈正相关,FT3、FT4与收缩压、舒张压、尿蛋白负相关,均为低度相关.正常组、亚临床甲减组、临床甲减组孕妇PE发生率依次为1.67%、5.00%、11.67%,差异有显著性,但三组PE程度比较差异无统计学意义.结论:妊娠期甲状腺功能指标与PE指标具有一定相关性,积极防治妊娠期甲减有助于预防PE发生.

Objective To analyze the correlation between hypothyroidism and preeclampsia (PE) during pregnancy. Methods 360 pregnant women who received pregnancy test and antenatal care in the hospital during the period from May 2016 to May 2017 were selected, and they were divided into the normal group (n=120), the subclinical hypothyroidism group (n=120) and the clinical hypothyroidism group (n=120). The clinical data of all pregnant women were collected, and indexes of thyroid function and urine protein were detected. The incidence of PE in the two groups was statistically analyzed. Results There was no significant difference in baseline data such as age, height, pregestational weight, gestational weeks and gravidity among the three groups. Levels of serum thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPOAb) showed the normal group < the subclinical hypothyroidism group < the clinical hypothyroidism group while levels of free triiodothyronine (FT3) and free thyroxine (FT4) showed the normal group > the subclinical hypothyroidism group > the clinical hypothyroidism group. The systolic pressure, diastolic pressure and urine protein showed the normal group < the subclinical hypothyroidism group < the clinical hypothyroidism group. TSH and TPOAb were positively correlated with the systolic blood pressure, diastolic blood pressure and urine protein in pregnant women with hypothyroidism while FT3 and FT4 were negatively correlated with the systolic blood pressure, diastolic blood pressure and urine protein, and the correlation was weak. The incidence rates of PE in the normal group, the subclinical hypothyroidism group and the clinical hypothyroidism group were 1.67%, 5.00% and 11.67%, respectively, with significant differences, but there was no significant difference in the degree of PE among the three groups. Conclusion There is a certain correlation between the indexes of thyroid function and indexes of PE during pregnancy, and active prevention of hypothyroidism during pregnancy is helpful to prevent the occurrence of PE.