妊娠期慢性淋巴细胞性甲状腺炎与妊娠结局的临床分析

Clinical analysis of chronic lymphocytic thyroiditis in gestational period and pregnancy outcome

目的:建立重庆医科大学附属第二医院正常妊娠妇女早、中、晚孕期甲状腺激素水平参考值范围,探讨妊娠期桥本甲状腺炎及妊娠期甲状腺功能减退对妊娠结局的影响。方法:选取2018年1月至2019年6月本院规律产检孕妇,收集血清促甲状腺激素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyronine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平,制定不同孕期甲状腺激素水平各项指标参考值范围。同时回顾性分析该时期诊断为桥本甲状腺炎者、妊娠期甲状腺功能减退者及同期甲状腺功能正常者,对3组围产结局进行对比。结果:(1)妊娠早期孕妇1216例,妊娠中期646例,妊娠晚期1287例。妊娠3期TSH参考范围分别为0.04~3.73μIU/mL、0.10~4.03μIU/mL、0.68~4.30μIU/mL。FT4分别为13.2~23.0 pmol/L、9.8~17.4 mol/L、10.7~20.1 pmol/L;FT3分别为3.8~6.2 pmol/L、3.3~5.7 pmol/L、3.1~5.0 pmol/L。(2)桥本组182例,甲状腺功能减退组180例,正常组180例。3组孕妇既往妊娠流产率比较,桥本组38例(31.4%),明显高于甲状腺功能减退组的19例(17.4%)及正常组的5例(4.8%),差异有统计学意义(P<0.05)。(3)桥本甲状腺炎组自发性早产12例(6.6%)、妊娠期糖尿病41例(22.5%),发生率分别高于甲状腺功能减退组的5例(2.8%)及30例(16.7%);高于正常组的3例(1.7%)及20例(11.1%),差异均有统计学意义(P<0.05)。(4)桥本组胎儿生长受限12例(6.6%),发生率高于甲状腺功能减退组的4例(2.2%)及正常组的2例(1.1%),差异均有统计学意义(P<0.05);3组新生儿出生体质量、身长、Apgar评分、脐血血气pH、BE值比较,差异均无统计学意义(P>0.05)。结论:妊娠不同时期,甲状腺功能各项指标参考值不同,因此建立本地区特异性甲状腺激素水平参考值范围有利于甲状腺疾病筛查及诊断。妊娠合并桥本甲状腺炎会增加流产、自发性早产、妊娠期糖尿病及胎儿生长受限的发生风险。妊娠期间应重视桥本甲状腺炎的诊治,同时进行甲状腺功能及TPO-Ab、TG-Ab筛查,做到早期诊断及治疗,降低不良妊娠风险。

Objective:To establish the reference value range of trimester-specific thyroid hormone in pregnant women in our hospital,and to explore the impact of chronic lymphocytic thyroiditis(Hashimoto’s thyroiditis)and hypothyroidism on pregnancy outcome.Methods:Levels of thyroid stimulating hormone(TSH),free thyronine(FT4)and free triiodothyronine(FT3)of pregnant women in our hospital from January 2018 to June 2019 were retrospectively collected and reference value ranges of different indexes in different trimesters were established.In addition,the pregnancy outcomes and neonate status of chronic lymphocytic thyroiditis,pregnancy hypothyroidism(TPO-Ab and TG-Ab negative)and normal pregnant women were retrospectively compared.Results:(1)There were 1216 women in the first trimester,646 in the second trimester and 1287 in the third trimester.The reference value range of serum TSH in three trimesters were 0.04-3.73μIU/mL,0.10-4.03μIU/mL and 0.68-4.32μIU/mL,respectively;FT4 were 13.2-23.0 pmol/L,9.8-17.4 pmol/L and 10.7-20.1 pmol/L;FT3 were 3.8-6.2 pmol/L,3.3-5.7 pmol/L and 3.1-5.0 pmol/L.(2)There were 182 women in the Hashimoto’s group,180 in the hypothyroidism group and 180 in the normal control group.For the comparison of previous abortion rate in three groups,there were 38 patients(31.4%)in the the Hashimoto’s group,which were significantly higher than19 patients(17.4%)of the hypothyroidism group and 5 patients(4.8%)of the normal group,with statistically significant difference(P<0.05).(3)In the Hashimoto’s thyroiditis group,12women had premature birth(6.6%)and 41 women had gestational diabetes mellitus(22.5%),which were higher than those in the antigen-negative hypothyroidism group(n=5,2.8%;n=30,16.7%)and in the normal group(n=3,1.7%;n=20,11.1%),with statistically significant differences(P<0.05).(4)In the Hashimoto’s group,12 women(6.6%)had fetal growth restriction,which was higher than that in the hypothyroidism group(n=4,2.2%)and the normal group(n=2,1.1%),with statistically significant differences(P<0.05).But there were no significant differences in birth weight,body length,Apgar score and blood gas analysis of p H and BE among three groups(P>0.05).Conclusion:The reference value range of thyroid function differs in different gestational periods.Therefore,establishing a reference range suitable for specific thyroid hormone is essential for screening and diagnosing thyroid diseases.Pregnancy complicated with chronic lymphocytic thyroiditis will increase the risk of miscarriage,premature delivery,gestational diabetes mellitus and fetal growth restriction.In order to diagnose thyroid diseases early and reduce the risk of adverse pregnancy outcome,diagnosis and treatment of Hashimoto’s thyroditis and screening thyroid function and TPO-Ab and TG-Ab are essential during pregnancy.