妊娠合并亚临床甲状腺功能减退症TSH值对新生儿甲功的影响

Correlation analysis between maternal subclinical hypothyroidism and neonatal abnormal thyroid function and the effect of TSH on neonatal thyroid function

目的探讨母亲亚临床甲减及孕期促甲状腺激素(TSH)达标与否对新生儿短期内甲功的影响。方法收集西安医学院第二附属医院2017年8月至2019年6月分娩的亚临床甲减孕妇167例为研究组,孕周≥37周,孕期药物治疗情况明确,选择同期满37周甲状腺功能正常的115例孕妇为对照组,比较两组低T4综合征、低T3综合征、低T4伴TSH延迟升高、孤立性高TSH血症、先天性甲减中所占比例;据母亲药物干预效果分为TSH达标组,未达标组,未治疗组和对照组,4组新生儿分别在出生后4天及出生后15天查甲功五项,分析TSH值的差异性。结果在不同类型中研究组的异常率均明显高于对照组,发病率较高的类型是高TSH血症(P<0.05);同一时间段4组间TSH的变化、达标组和未达标组差异有统计学意义(P<0.05),未达标组和未治疗组,达标组和对照组差异无统计学意义(P>0.05)。随着日龄的增长,未治疗组中TSH值差异有统计学意义(P<0.05),达标组、未达标组和对照组TSH值差异无统计学意义(P>0.05)。结论孕期亚临床甲状腺功能减退会影响新生儿的甲功,且主要导致新生儿生后高TSH血症的发生,孕期TSH达标,新生儿生后TSH值基本正常。

Objective To explore the impact of maternal subclinical hypothyroidism and the achievement of thyroid stimulating hormone(TSH)during pregnancy on short-term neonatal function.Methods A total of 167 pregnant women with subclinical hypothyroidism who were delivered from August 2017 to June 2019 in the Second Affiliated Hospital of Xi′an Medical College were collected as the study group.The gestational age was≥37 weeks.The drug treatment during pregnancy was clear.115 pregnant women with normal thyroid function at 37 weeks were selected as the control group.The proportions of low T4 syndrome,low T3 syndrome,low T4 with delayed increase in TSH,isolated hyperTSHemia,and congenital hypothyroidism were compared between the two groups.According to the effect of the mother′s drug intervention,they were divided into TSH standard group,non-standard group,untreated group and control group.The newborns in the 4 groups were tested for five items of thyroid function at 4 days after birth and 15 days after birth,and the differences in TSH values were analyzed.Results Among the different types,the abnormal rate of the study group was significantly higher than that of the control group,and the type with higher incidence was hyper TSH(P<0.05);There were statistically significant differences in the changes of TSH between the four groups in the same time period,and the difference between the standard group and the non-standard group(P<0.05).There was no statistically significant difference between the non-compliance group and the untreated group,and between the attainment group and the control group(P>0.05).With the increase of the age,the difference of TSH value in the untreated group was statistically significant(P<0.05),and there was no statistically significant difference in the TSH value of the attained group,the unattained group and the control group(P>0.05).Conclusion Subclinical hypothyroidism during pregnancy will affect the neonatal thyroid function,and it mainly leads to lead to the occurrence of neonatal hyper TSH after birth.TSH reaches the standard during pregnancy,and the TSH value after birth is basically normal.