TPO-Ab阴性的低甲状腺素血症和SCH与不良妊娠结局的相关性分析

The correlation analysis of TPO AB negative hypothyroidism,sch and adverse pregnancy outcome

目的探讨妊娠中期(12~28周)和妊娠晚期(≥28周)抗甲状腺过氧化物酶抗体(TPO-Ab)阴性的亚临床甲状腺功能减退症(简称甲减)和低甲状腺素血症与不良妊娠结局之间的关系.方法回顾性分析2016年1月至2018年12月在本院产检的19884例妊娠期妇女的甲状腺功能水平,排除相关影响因素以及TPO-Ab阳性患者,根据本院妊娠期甲状腺功能特异性参考值范围,将妊娠中、晚期妇女各分为甲状腺功能正常组、单纯性低甲状腺素血症组(IMH)、TPO-Ab阴性亚临床甲减组(SCH/TPO-),分析并比较各组不良妊娠结局的发生率.结果妊娠中期或晚期的TPO-Ab阴性亚临床甲减与正常组相比,其母胎不良妊娠结局无明显差异(P>0.05);而妊娠中期和妊娠晚期的单纯性低甲状腺素血症合并妊娠期糖尿病(GDM)的发生率较正常组及TPO-Ab阴性亚临床甲减显著升高(P<0.05);妊娠中期的单纯性低甲状腺素血症出现产后出血、胎膜早破和巨大儿的发生率较同孕期正常组和TPO-Ab阴性亚临床甲减明显增加(P<0.05).结论妊娠中期或晚期的TPO-Ab阴性亚临床甲减与不良妊娠结局之间无显著相关性;妊娠中期或晚期的单纯性低甲状腺素血症与GDM密切相关,且提示甲状腺功能减退发生GDM可能与低FT4而非高TSH有关;妊娠期中期单纯性低甲状腺素血症还与巨大儿、产后出血及胎膜早破相关,且这些不良妊娠结局之间相互独立.

Objective To investigate the relationship between thyroid peroxidase antibody(TPO-Ab)negative subclinical hypothyroidism and isolated hypothyroxemia with adverse pregnancy outcomes in the second trimester(12~28weeks)and the third trimester(≥28weeks).Methods The thyroid function levels were retrospectively analyzed in 19,884 pregnant women who were examined in our hospital from 2016 to 2018,and exclude relevant influencing factors and thyroid peroxidase antibody positive patients.Finally,these data were divided into the normal thyroid function group,the Isolated hypothyroxemia(IMH),and the Subclinical hypothyroidism(SCH/TPO-)according to the range of thyroid function-specific reference values during pregnancy,to analyze and compare the incidence of adverse pregnancy outcomes in each group.Results TPO-Ab negative subclinical hypothyroidism in the second trimester or the third trimester of pregnancy had no significant difference in maternal fetal adverse pregnancy outcome compared with the normal group(P>0.05).The incidence of simple hypothyroxinemia with gestational diabetes mellitus(GDM)in the second trimester or the third trimester was 14.74% and 16.67%.Compared with the normal group and the TPO-Ab negative subclinical hypothyroidism were significantly increased(P<0.05).The incidence of postpartum hemorrhage,premature rupture of membranes,and macrosomia in the second trimester was higher than that in the normal group.Compared with TPO-Ab negative subclinical hypothyroidism was also significantly increased(P<0.05).Conclusion There is no significant association between TPO-Ab negative subclinical hypothyroidism and adverse pregnancy outcomes in the second trimester or the third trimester.The Isolated hypothyroxemia in the second trimester or the third trimester is closely related to GDM,and suggests that GDM may be associated with low FT4 but not high TSH.The Isolated hypothyroxemia in the second trimester is also associated with macrosomia,postpartum hemorrhage,and premature rupture of membranes,and these adverse pregnancy outcomes are independent of each other.