妊娠期高血压疾病对孕期甲状腺功能的影响

Effect of Hypertensive Disorder Complicating Pregnancy on Thyroid Function during Pregnancy

【目的】探讨妊娠期高血压疾病对孕期甲状腺功能的影响。【方法】选取120例妊娠期高血压疾病孕妇作为观察组,其中妊娠高血压48例,子痫前期40例,子痫32例。选取本院同期定期体检的健康孕妇120例作为对照组。检测各组孕早期(<12周)、孕中期(12~28周)、孕晚期(>28周)外周血促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)及甲状腺过氧化物酶抗体(TPOAb)水平,并观察孕期甲状腺异常的发生情况。【结果】随着孕期增加,观察组TSH、TPOAb阳性率逐渐增高,FT3、FT4逐渐降低。孕早期和中期,观察组FT3显著低于对照组(P<0.05);孕中期和晚期,观察组TSH高于对照组(P<0.05),FT4显著低于对照组(P<0.05);孕晚期,观察组TPOAb阳性率高于对照组(P<0.05)。子痫孕妇孕早期及中期FT3、孕中期和晚期FT4均显著低于妊娠高血压孕妇(P<0.05);子痫孕妇孕中期和晚期TSH、孕晚期TPOAb阳性率显著高于妊娠高血压孕妇(P<0.05);子痫孕妇孕中期和晚期TSH高于子痫前期孕妇(P<0.05)。观察组亚临床甲减累积发生率、甲状腺功能异常总发生率高于对照组(P<0.05);子痫孕妇孕期亚临床甲减及甲状腺功能异常总发生率高于子痫前期和妊娠高血压孕妇(P<0.05)。亚临床甲减累积发生率与子痫呈正相关(P<0.05)。【结论】妊娠期高血压疾病孕妇甲状腺功能异常发生率较高,尤其是子痫孕妇,临床应重视该类患者甲状腺功能的筛查。

【Objective】To investigate the changes of thyroid function and the occurrence of thyroid dysfunction during pregnancy with hypertensive disorder complicating pregnancy(HDCP).【Methods】A total of 120 pregnant women with hypertensive disorder complicating pregnancy were selected as the observation group,including 48 cases of pregnancy-induced hypertension,40 cases of pre-eclampsia,and 32 cases of eclampsia.In the same time period,120 pregnant women with normal blood pressure,no internal and obstetric complications were selected as the control group.The levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free tetraiodothyronine(FT4),and thyroid peroxidase antibodies(TPOAb)in early pregnancy(first trimester<12 weeks),second trimester(12-28 weeks),and late pregnancy(third trimester>28 weeks)were detected and the occurrence of thyroid abnormalities during pregnancy were recorded.【Results】With the increase of pregnancy,the TSH level and TPOAb positive rate in the observation group gradually increased,while both FT3 and FT4 gradually decreased.In the first and second trimesters of pregnancy,the FT3 of the observation group was lower than that of the control group(P<0.05).In the second and third trimesters,the TSH of the observation group was higher than that of the control group(P<0.05),while the FT4 was lower than that of the control group(P<0.05).In the late pregnancy,the positive rate of TPOAb in the observation group was higher than that in the control group(P<0.05).The positive rate of TPOAb in the observation group was higher than that in the control group(P<0.05).The FT3 in the first and second trimester,FT4 in the second and third trimester in eclampsia pregnant women were lower than those in pregnancy-induced hypertension women(P<0.05).The positive rate of TPOAb in late pregnancy,TSH in mid-pregnancy and late pregnancy in eclampsia women were higher than those in pregnancy-induced hypertension women(P<0.05).The TSH of pregnant women with eclampsia was higher in the second and late trimester than those with preeclampsia(P<0.05).The cumulative incidence of subclinical hypothyroidism and the total incidence of thyroid dysfunction in the observation group were higher than those in the control group(P<0.05).The incidence of subclinical hypothyroidism and thyroid dysfunction in eclampsia women was higher than that in pre-eclampsia and pregnancy-induced hypertension pregnant women(P<0.05).The cumulative incidence of subclinical hypothyroidism was positively correlated with severity of eclampsia(P<0.05).【Conclusion】The incidence of thyroid dysfunction in pregnant women with hypertensive disorder complicating pregnancy is high,especially in pregnant women with eclampsia.The screening of thyroid function in these patients should be paid attention to in clinical practice.