血清促甲状腺激素、游离甲状腺素、甲状腺过氧化物酶抗体水平检测在胎盘早剥诊断中的价值

Value of Detecting Serum TSH,FT4 and TPOAb Levels in the Diagnosis of Placental Abruption

目的探讨促甲状腺激素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb)水平检测在胎盘早剥诊断中的价值。方法选取2017年9月至2018年8月,于成都医学院第一附属医院进行治疗的胎盘早剥患者90例作为研究组;抽取同期入院,孕周>28周且顺利分娩的86例产妇作为对照组。对两组临床资料进行回顾性分析,采用单因素和多因素Logistic回归分析胎盘早剥的预测因素,ROC曲线分析血清TSH、FT4、TPOAb水平检测对胎盘早剥的诊断价值。结果妊娠期高血压、血清TSH水平≥2.5或<0.1 mIU/L、血清FT4水平<12 pmol/L和血清TPOAb水平≥34 IU/mL是孕妇发生胎盘早剥的重要预测因素;且血清TSH、FT4、TPOAb水平联合诊断胎盘早剥的AUC值明显高于三者单项诊断(P<0.01),截断值分别为:3.049 mIU/L、13.742 pmol/L、30.630 IU/mL;相关性分析结果显示,TSH与FT4呈负相关,TSH与TPOAb呈正相关,FT4与TPOAb呈负相关;产妇妊娠期高血压与其血清TSH、TPOAb值呈负相关,与FT4呈正相关,差异均有统计学意义(P<0.05)。结论血清TSH、FT4、TPOAb水平均与胎盘早剥相关,血清三项指标联合检测对临床预测与诊断胎盘早剥具有一定应用价值。

Objective To explore the value of detecting the serum thyroid stimulating hormone(TSH),free thyroxine(FT4)and thyroid peroxidase antibody(TPOAb)levels in the diagnosis of placental abruption.Methods A total of 90 patients with placental abruption treated in The First Affiliated Hospital of Chengdu Medical College from September of 2017 to August of 2018 were enrolled into the study group.The other 86 puerperae with the gestational age of more than 28 weeks delivering successfully over the corresponding period were selected into the control group.The clinical data of both groups were analyzed retrospectively.The predictive factors of placental abruption were analyzed by the univariate and multivariate Logistic regression analysis.The ROC curves were performed to analyze the diagnostic value of detecting the serum TSH,FT4 and TPOAb levels for placental abruption.Results Gestational hypertension,the serum TSH level of no less than 2.5mIU/L or less than 0.1mIU/L,the serum FT4 level of less than 12pmol/L and the serum TPOAb level of no less than 34IU/mL were important predictors for placental abruption in pregnant women.The AUC value of the diagnosis with the combined detection of the serum TSH,FT4 and TPOAb levels was higher than that of the diagnosis with the single detection of the serum TSH,FT4 and TPOAb levels(P<0.01),and their cutoff values were 3.049mIU/L,13.742pmol/L and 30.630IU/mL,respectively.According to the results of the correlation analysis,the TSH level was negatively correlated with the FT4 level and positively correlated with the TPOAb level,the FT4 level was negatively correlated with the TPOAb level,and gestational hypertension was negatively correlated with the TSH and TPOAb levels and positively correlated with the FT4 level(P<0.05).Conclusion The levels of serum TSH,FT4 and TPOAb are all correlated with placental abruption,and the combined detection of the three serum indexes is of certain application value in the clinical prediction and diagnosis of placental abruption.