摘要
目的:应用血清FT4、TSH、TPOAb筛查妊娠合并甲状腺功能减退症(甲减)高危人群,建立本地域检测指标的特异性参考范围,并进行规范化管理,以降低其母婴不良结局。方法:选择3406例妊娠妇女作为研究对象,其中甲减孕妇100例作为对照组,只接受血清FT4+TSH筛检;100例在对照组的基础上联合TPOAb筛检,作为研究组A;研究组B应用FT4+TSH+TPOAb联合筛检,诊断依据采用本地FT4+TSH的P2.5~P97.5诊断范围。初步确定本地区甲减诊断范围并进行规范化管理,评估妊娠期甲减发生情况及母婴不良结局。结果:设立本院孕期<13周孕妇血清FT4和TSH的P2.5~P97.5分别为(0.70~3.69)ng/dL、(0.36~4.60)mU/L。研究组B剖宫产率为40.00%,低于对照组48.00%,研究组B和研究组A妊娠不良事件总发生率分别为14.00%和18.00%,低于对照组26.00%,差异有统计学意义(P<0.05)。研究组B和研究组A胎儿及新生儿不良结局总发生率分别为5.00%和8.00%,均低于对照组17.00%,差异有统计学意义(P<0.05)。结论:在国家甲减妊娠诊断基础上,根据实际情况探讨本地诊断指标具有可行性;按照本地区指标进行诊断并进行干预,甲减患者母婴不良结局显著降低。
Objective:Serum FT4,TSH and TPOAb were used to screen the high-risk population of pregnancy with hypothyroidism,establish the specific reference range of local detection indicators,and carry out standardized management to reduce the adverse outcomes of mothers and infants.Methods:3 406 pregnant women were selected as the research object,of which 100 cases of hypothyroidism pregnant women as the control group received serum FT4+TSH screening only.100 cases of hypothyroidism pregnant women combined with TPOAb screening on the basis of the control group,as study group A,study group B used FT4+TSH+TPOAb combined screening,diagnosis was based on the local FT4+TSH P2.5-P97.5 diagnostic range.The diagnostic scope of hypothyroidism in this area was initially determined and standardized management was carried out to evaluate the occurrence of hypothyroidism in pregnancy and adverse outcomes of mothers and infants.Results:The P2.5-P97.5 of serum FT4 and TSH were(0.70-3.69)ng/dL and(0.36-4.60)mU/L for pregnant women less than 13 weeks of gestation.The rate of cesarean section in study group B was 40.00%,which was lower than that in control group(48.00%).The total incidence of adverse pregnancy events in study group B and study group A was 14.00%and 18.00%,respectively,which were lower than that in control group(26.00%),the difference was statistically significant(P<0.05).The total incidence of adverse outcomes of fetuses and newborns in study group B and A were 5.00%and 8.00%,respectively,which were lower than 17.00%in control group,the difference was statistically significant(P<0.05).Conclusion:On the basis of the national diagnosis of hypothyroidism pregnancy,it is feasible to explore the local diagnostic indicators according to the actual situation;diagnosis and intervention were implemented according to the local indicators,the adverse outcomes of mothers and infants of hypothyroidism patients are significantly reduced.
作者
李倩
代明甫
钟家妮
向茜
LI Qian;DAI Ming-fu;ZHONG Jia-ni;XIANG Qian(Department of Obstetrics and Gynecology,Shifang Maternal and Child Health Hospital,Shifang 618400,Sichuan,China;Department of Health Management,Shifang Maternal and Child Health Hospital,Shifang 618400,Sichuan,China;Department of Laboratory,Shifang Maternal and Child Health Hospital,Shifang 618400,Sichuan,China)
出处
《川北医学院学报》
CAS
2019年第5期586-588,592,共4页
Journal of North Sichuan Medical College
基金
四川省什邡市应用技术开发项目[什市科知发(2014)44号]