孕期内TPO-Ab阴性的亚甲减对初产妇妊娠和分娩结局分析

Analysis of TPO-Ab-negative subclinical hypothyroidism during pregnancy on pregnancy and delivery outcomes in primiparas

目的探讨孕期内TPO-Ab阴性的亚甲减对初产妇妊娠和分娩结局的影响。方法选取2017年8月~2018年8月于我院明确诊断为亚临床甲减的207例初产妇作为实验对象,根据孕期分为A、B、C三组,采用化学发光免疫分析法测定血清中TSH水平,记录并比较三组实验对象TSH水平,并随访三组实验对象的妊娠和分娩结局。结果三组实验对象血清中的TSH水平存在明显差异(P<0.05);随访三组的妊娠结局发现,A、B、C三组妊娠期糖尿病、胎膜早破、妊娠期贫血、产后出血及早产的发生率比较,差异有统计学意义(P<0.05),另外A、B、C三组妊娠期间发生妊娠期高血压、前置胎盘等方面的概率无明显差异(P>0.05);观察三组实验对象胎儿情况发现,A、B、C三组的胎儿发生低出生体重及新生儿生长受限的概率,差异有统计学意义(P<0.05),而A、B、C三组胎儿发生巨大儿、胎内呼吸窘迫等方面的概率无明显差异(P>0.05)。结论TPO-Ab阴性的亚临床甲减的初产妇在不同孕期产生TSH的定量不同,从而影响产妇的妊娠结局及胎儿的情况,因此对不同孕期TSH的监测及控制对TPO-Ab阴性的亚临床甲减初产妇的妊娠及分娩结局具有重要的意义,值得在临床上极力推广。

Objective To explore the effect of TPO-Ab-negative subclinical hypothyroidism during pregnancy on pregnancy and delivery outcomes in primiparas.Methods A total of 207 primiparas who were clearly diagnosed with subclinical hypothyroidism in our hospital from August 2017 to August 2018 were selected as experimental subjects.They were divided into three groups of A,B,and C according to pregnancy terms.Chemiluminescence immunoassay was used to determine the level of TSH in serum.The TSH levels were recorded and compared between the three groups of subjects,and the pregnancy and delivery outcomes of the three groups of subjects were followed up.Results The TSH levels of the three groups of subjects were compared,and it was found that there were significant differences in the serum TSH levels between the three groups of subjects,and the differences were statistically significant(P<0.05);During the follow-up of the pregnancy outcomes of the three groups,the incidence rates of gestational diabetes,premature rupture of membranes,anemia during pregnancy,postpartum hemorrhage and preterm birth were different between group A,group B and group C,and the differences were statistically significant(P<0.05).In addition,there was no significant difference in the incidence rate of pregnancy-related hypertension and placenta previa during pregnancy in the three groups of A,B,and C,and the differences were not statistically significant(P>0.05);The infants in the three groups of subjects were observed,and it was found that the incidence rates of low birth weight infant and neonatal growth restriction were different in group A,B and C,and the differences were statistically significant(P<0.05).However,there was no significant difference in the probability of fetal giantness and intra-natal respiratory distress among the three groups of A,B,and C,and the differences were not statistically significant(P>0.05).Conclusion The quantity of TSH produced by primiparas with TPO-Ab-negative subclinical hypothyroidism is different in different pregnancy trimesters,which affects the pregnancy outcome of the puerpera and the condition of the infants.Therefore,the monitoring and control of TSH in different pregnancy trimemsters is of great significance to the pregnancy and delivery outcomes of primiparas with TPO-Ab-negative subclinical hypothyroidism,and it is worthy of clinical promotion.