孕期甲状腺激素水平与新生儿甲状腺功能的关系研究

Relationship between thyroid hormone levels during pregnancy and neonatal thyroid function

目的:探讨孕期甲状腺激素水平与新生儿甲状腺功能的关系。方法:选取永康市第一人民医院2019年7月至2020年8月收治的孕期促甲状腺激素(TSH)异常的孕产妇及其新生儿40例为观察组,选取同时间段健康孕产妇及其新生儿38例为对照组,对两组临床资料进行回顾性分析。对比两组孕产妇孕期甲状腺激素[三碘甲状原氨酸(T_(3))、四碘甲状腺原氨酸(T_(4))、促甲状腺激素(TSH)、游离T_(3)(FT_(3))、游离T_(4)(FT_(4))]水平,对比两组新生儿TSH水平,统计两组新生儿中甲状腺功能异常发生情况,分析孕期甲状腺激素水平与新生儿TSH水平的相关性。 结果:观察组孕期TSH[(2.89±0.44)mU/L]高于对照组[(2.13±0.22)mU/L]( t=9.570, P<0.001),T_(3)[(0.45±0.07)μg/L]、T_(4)[(90.87±8.93)μg/L]、FT_(3)[(1.08±0.19)ng/L]、FT_(4)[(10.45±1.73)ng/L]均低于对照组[(2.13±0.22)μg/L、(1.31±0.21)μg/L、(2.16±0.34)ng/L、(15.31±2.21)ng/L]( t=24.514、9.254、17.432、10.845,均 P<0.001);观察组新生儿TSH水平高于对照组( t=37.041, P<0.05);观察组新生儿甲状腺功能异常发生率高于对照组(χ^(2)=4.780, P<0.05);孕期TSH水平与新生儿TSH水平呈正相关( r=0.819, P<0.05),孕期T_(3)、T_(4)、FT_(3)、FT_(4)水平与新生儿TSH水平均呈负相关( r=-0.773、-0.802、-0.794、-0.824,均 P<0.05)。 结论:与健康孕产妇相比,孕期甲状腺激素水平异常孕产妇表现为TSH水平高,T_(3)、T_(4)、FT_(3)、FT_(4)水平低;其新生儿TSH水平高,且甲状腺功能异常发生风险高;孕期甲状腺激素水平与新生儿甲状腺功能相关。该研究有科学性、创新性。

Objective To investigate the relationship between thyroid hormone levels during pregnancy and neonatal thyroid function.Methods Forty pregnant women with abnormal thyroid stimulating hormone(TSH)level during pregnancy and their newborns who received treatment in Yongkang First People's Hospital,China between July 2019 and August 2020 were included in the observation group.An additional 38 healthy pregnant women and their newborns who concurrently received health examination were included in the control group.The clinical data in the two groups were retrospectively analyzed.The levels of thyroid hormones[(triiodothyronine(T_(3)),tetraiodothyronine(T_(4)),TSH,free T_(3)(FT_(3)),free T_(4)(FT_(4))]in pregnant women were compared between the two groups.TSH level in newborns was compared between the two groups.Thyroid dysfunction in newborns was assessed in each group.The correlation between thyroid hormone levels during pregnancy and neonatal thyroid function was analyzed.Results TSH level during pregnancy in the observation group was significantly higher than that in the control group[(2.89±0.44)mU/L vs.(2.13±0.22)mU/L,t=9.570,P<0.001].T_(3),T_(4),FT_(3) and FT_(4) in the observation group were(0.45±0.07)μg/L,(90.87±8.93)μg/L,(1.08±0.19)ng/L and(10.45±1.73)ng/L,respectively,which were significantly lower than those in the control group[(2.13±0.22)μg/L,(1.31±0.21)μg/L,(2.16±0.34)ng/L,(15.31±21)ng/L,t=24.514,9.254,17.432,10.845,all P<0.001].TSH level in newborns in the observation group was significantly higher than that in the control group(t=37.041,P<0.05).The incidence of thyroid dysfunction in the observation group was significantly higher than that in the control group(χ^(2)=4.780,P<0.05).TSH level in pregnant women was positively correlated with that in newborns(r=0.819,P<0.05).T_(3),T_(4),FT_(3) and FT_(4) levels in pregnant women were negatively correlated with TSH level in newborns(r=-0.773,-0.802,-0.794,-0.824,all P<0.05).Conclusion Compared with healthy pregnant women,pregnant women with abnormal thyroid hormone levels have higher TSH levels and lower T_(3),T_(4),FT_(3) and FT_(4) levels.The newborns of pregnant women with abnormal thyroid hormone levels have higher TSH levels and a greater risk of thyroid dysfunction than the newborns of healthy pregnant women.The level of thyroid hormone during pregnancy is related to the thyroid function of newborns.This study is scientific and innovative.