先兆流产早期血清Hcy、TPOAb、TGAb水平的变化及其预后分析

Changes of serum Hcy,TPOAb,and TGAb levels in early threatened abortion and their prognostic analysis

目的分析先兆流产早期孕妇血清同型半胱氨酸(Hcy)、甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)水平的变化及其对预后的影响。方法选取湛江市第二人民医院妇产科于2019年1月至2020年10月收治的79例因早期先兆流产行保胎治疗的孕妇为研究对象(保胎组),并根据其甲状腺功能分为甲功正常组43例和甲减组36例,另选取79例同期于本院产检的正常孕妇作为对照组。检测并比较先兆流产行保胎治疗的孕妇和对照组孕妇的血清Hcy、TPOAb、TGAb水平,采用Spearman秩相关分析法分析血清Hcy、TPOAb、TGAb水平与早期先兆流产的相关性;比较甲功正常组和甲减组孕妇的TPOAb、TGAb阳性检测率;先兆流产行保胎治疗的孕妇给予药物治疗,随访至妊娠结束,比较甲功正常组和甲减组孕妇的妊娠结局。结果保胎组孕妇的血清Hcy、TPOAb、TGAb水平分别为(5.57±2.27)μmol/L、(214.71±12.81)IU/mL、(134.27±15.16)IU/mL,明显高于对照组的(4.52±2.51)μmol/L、(1.74±0.28)IU/mL、(0.98±0.10)IU/mL,差异均有统计学意义(P<0.05);血清Hcy、TPOAb、TGAb水平与早期先兆流产呈正相关(r=0.495、0.532、0.501,P<0.01);甲减组孕妇的TPOAb、TGAb阳性检测率分别为30.56%、36.11%,明显高于甲功正常组的9.30%、13.95%,差异均有统计学意义(P<0.05);治疗后,甲功正常组和甲减组保胎结局比较差异无统计学意义(P>0.05)。结论血清Hcy、TPOAb、TGAb水平与早期先兆流产发生具有一定相关性,且甲状腺功能减退是主要原因之一,可通过药物治疗提高保胎率,改善妊娠结局。

Objective To analyze the changes of serum homocysteine(Hcy),thyroid peroxidase antibody(TPOAb),anti-thyroglobulin antibody(TGAb)levels in early threatened abortion and their influence on the prognosis.Methods A total of 79 pregnant women with early threatened abortion,who admitted to Department of Obstetrics and Gynecology,Zhanjiang Second People's Hospital from January 2019 to September 2020,were selected as the observation group.The patients were divided into the normal thyroid function sub group(n=43)and hypothyroidism sub group(n=36)according to their thyroid function,and another 79 normal pregnant women who were undergoing obstetrics in the hospital during the same period were selected as the control group.The serum Hcy,TPOAb and TGAb levels of pregnant women in the observation group and the control group were tested and compared.Spearman rank correlation analysis was used to analyze the correlation between serum Hcy,TPOAb,TGAb levels and early threatened abortion;the positive detection rates of TPOAb and TGAb in the normal group and the hypothyroidism group were compared.The observation group was given medication and followed up until the end of pregnancy,and the pregnancy outcome of the normal and hypothyroid group was compared.Results The serum Hcy,TPOAb,and TGAb levels of pregnant women in the observation group were(5.57±2.27)μmol/L,(214.71±12.81)IU/mL,(134.27±15.16)IU/mL,respectively,which were significantly higher than corresponding(4.52±2.51)mmol/L,(1.74±0.28)IU/mL,(0.98±0.10)IU/mL of the control group(all P<0.05);the serum Hcy,TPOAb,TGAb levels were positively correlated with early threatened abortion(r=0.495,0.532,0.501,P<0.01);the positive detection rates of TPOAb and TGAb of pregnant women in the hypothyroidism sub group were 30.56%and 36.11%,respectively,which were significantly higher than 9.30%and 13.95%of the normal thyroid function sub group(P<0.05).After treatment,there was no significant difference in the fetal preservation outcome between the normal thyroid function group and the hypothyroidism group(P>0.05).Conclusion Serum levels of Hcy,TPOAb,and TGAb have a certain correlation with the occurrence of early threatened abortion,and hypothyroidism is one of the main reasons.Drug treatment can be used to increase the pregnancy rate and improve pregnancy outcome.