双胎妊娠不同孕期血清甲状腺功能指标的参考范围及甲状腺功能对母婴结局的影响

Reference ranges of serum thyroid function indexes in different pregnancy stages of twin pregnancy and effect of thyroid function on maternal-neonatal outcomes

目的建立双胎妊娠不同孕期血清甲状腺功能指标的参考范围,并探讨甲状腺功能对母婴结局的影响。方法纳入307例双胎妊娠孕妇的临床资料,检测其孕早期、孕中期、孕晚期甲状腺功能指标水平,采用百分位数法建立血清促甲状腺激素(TSH)、游离四碘甲状腺原氨酸(FT 4)参考范围。根据所得参考范围将孕妇分为甲状腺功能正常组274例、甲状腺功能亢进组17例、甲状腺功能减退组16例,随访并对比3组不良妊娠结局以及围产儿不良结局发生率。结果纳入的双胎妊娠孕早、中、晚期孕妇血清TSH正常参考范围依次为0.02~4.94 mIU/L、0.12~5.89 mIU/L、0.23~6.95 mIU/L,血清FT 4正常参考范围依次为10.91~21.24 pmol/L、10.20~21.34 pmol/L、8.70~20.95 pmol/L。甲状腺功能正常组母体总不良妊娠结局发生率、胎儿/围产儿总不良结局发生率均低于甲状腺功能亢进组、减退组(均P<0.01)。结论双胎妊娠孕妇不同孕期血清甲状腺功能指标具有特异性,或可依据上述血清甲状腺功能指标的参考范围评价本地区双胎妊娠孕妇不同孕期的甲状腺功能;甲状腺功能异常的双胎妊娠的母体妊娠及围产儿不良结局的发生率均较高。

Objective To establish the reference ranges of serum thyroid function indexes in different pregnancy stages of twin pregnancy,and to explore the effect of thyroid function on maternal-neonatal outcomes.Methods A total of 307 women with twin pregnancy were enrolled,and the levels of thyroid function indexes in the first,second and third trimester were determined,then the reference ranges of serum thyroid-stimulating hormone(TSH)and free tetraiodothyronine(FT 4)were established by using the percentiles method.The pregnant women were divided into normal thyroid function group(n=274),hyperthyroidism group(n=17)and hypothyroidism group(n=16)according to the reference ranges established,then the incidence rates of adverse pregnancy outcomes and perinatal outcomes were followed up and compared among the three groups.Results For the twin pregnancy women enrolled during the first,second and third trimester,the normal reference ranges of serum TSH were 0.02 to 4.94 mIU/L,0.12 to 5.89 mIU/L and 0.23 to 6.95 mIU/L,successively,and the normal reference ranges of serum FT 4 were 10.91 to 21.24 pmol/L,10.20 to 21.34 pmol/L and 8.70 to 20.95 pmol/L,successively.The total incidence rate of adverse maternal pregnancy outcomes or neonatal/perinatal outcomes was lower in the normal thyroid function group than in the hyperthyroidism or hypothyroidism group(all P<0.01).Conclusion Twin pregnant women during various pregnancy stages have specific serum thyroid function indexes,the thyroid function during various pregnancy stages of twin pregnant women from local region may be evaluated according to the reference ranges of aforementioned serum thyroid function indexes;the incidence rates of adverse maternal pregnancy and perinatal outcomes are relatively higher in women with twin pregnancy having abnormal thyroid function.