孕妇年龄及孕早期亚临床甲状腺功能减退与子痫前期的相关性分析

Analysis on the correlations between maternal age,subclinical hypothyroidism during the first trimester of pregnancy and preeclampsia

目的探讨年龄及孕早期亚临床甲状腺功能减退(SCH)与子痫前期及其亚型的相关性,为不同年龄孕早期SCH患者孕期监测制定个体化策略提供科学依据。方法以2016年1月-2017年10月在甘肃省妇幼保健院高危产科产检SCH单胎活产孕妇为研究对象,使用Logistics回归模型分别分析年龄及孕早期SCH与子痫前期的相关性。结果控制混杂因素后,与适龄患者相比,高龄患者重度子痫前期发生风险升高36.00%(OR=1.36,95%CI:1.73~5.53)。与甲状腺功能(甲功)正常患者相比,甲状腺过氧化物酶抗体(TPOAb)阳性(+)SCH患者发生子痫前期、轻度/重度子痫前期风险分别增加1.38倍、1.30倍和1.66倍(OR子痫前期=2.38,95%CI:1.49~3.79,OR轻度子痫前期=2.3,95%CI:1.35~3.92,OR重度子痫前期=2.66,95%CI:1.24~6.67)。交互作用分析,与适龄甲功正常患者相比,适龄TPOAb(+)SCH患者轻度子痫前期发生风险升高1.45倍(OR=2.45,95%CI:1.23~4.93),重度子痫前期风险升高3.39倍(OR=4.49,95%CI:1.78~11.38);高龄TPOAb阴性(-)SCH患者发生重度子痫前期的风险升高4.20倍(OR=5.20,95%CI:1.43~19.22),二者相乘交互作用差异有统计学意义(P<0.01)。结论TPOAb(+)SCH患者发生子痫前期及其亚型的风险升高。不同年龄TPOAb(-)SCH人群发生子痫前期及其亚型的风险不一致,高龄者发生子痫前期及重度子痫前期的风险显著高于适龄及低龄者。对该类型SCH患者应根据年龄进行风险分层,开展个体化孕期管理和用药指导,降低子痫前期发生风险。

Objective To explore the correlations between maternal age,subclinical hypothyroidism(SCH)during the first trimester of pregnancy and preeclampsia,provide a scientific basis for individualized strategy-making of monitoring during pregnancy among SCH patients during the first trimester of pregnancy in different age groups.Methods The monotocous live birth pregnant women with SCH receiving prenatal examination in Department of High-Risk Obstetrics in Gansu Provincial Maternal and Child Health Care Hospital from January2016 to October 2017 were selected,Logistic regression model was used to analyze the correlations between maternal age,SCH during the first trimester of pregnancy and preeclampsia.Results After controlling the confounding factors,compared with the patients of the right age,the risk of severe preeclampsia in elderly women increased by 36.00%(OR=1.36,95%CI:1.73-5.53).Compared with the patients with normal thyroid function,the risks of preeclampsia,mild/severe preeclampsia in SCH patients with positive thyroid peroxidase antibody(TPOAb)increased by 1.38 times,1.30,times,and 1.66 times,respectively(ORpreeclampsia=2.38,95%CI:1.49-3.79,ORmild preeclampsia=2.3,95%CI:1.35-3.92,ORsevere preeclampsia=2.66,95%CI:1.24-6.67).Interactive analysis showed that compared with the patients of the right age with normal thyroid function,the risk of mild preeclampsia in SCH patients with positive TPOAb increased by1.45 times(OR=2.45,95%CI:1.23-4.93),the risk of severe preeclampsia increased by 3.39 times(OR=4.49,95%CI:1.78-11.38).The risk of severe preeclampsia in elderly SCH patients with negative TPOAb increased by 4.20 times(OR=5.20,95%CI:1.43-19.22).There was statistically significant difference in multiplicative interaction between the two groups(P<0.01).Conclusion The risks of preeclampsia and the subtypes in SCH patients with positive TPOAb increase.The risks of preeclampsia and the subtypes in SCH patients with negative TPOAb are not consistent among different age groups.The risks of preeclampsia and severe preeclampsia in elderly patients were significantly higher than those in patients of the right age and low age.Risk stratification of the SCH patients should be conducted according to age,individualized pregnancy management and medication guidance should be carried out to reduce the risk of preeclampsia.