全血硒水平与妊娠晚期甲状腺功能减退的关系及对妊娠结局的影响

The relationship between the level of whole blood selenium and hypothyroidism in the third trimester and its influence on pregnancy outcome

目的 探讨全血硒水平与妊娠晚期甲状腺功能减退(甲减)的关系及对妊娠结局的影响。方法 选取2019年1月至2020年9月于陕西中医药大学第二附属医院接受孕期检查的414例妊娠晚期女性。根据甲状腺功能检测结果,将414例孕妇分为甲减组(包括临床甲减及亚临床甲减,33例)和正常组(甲状腺功能正常,381例)。分析孕妇的全血硒水平及甲减发生率。比较甲减组与正常组孕妇的临床资料,采用多因素Logistic回归方法分析妊娠晚期孕妇发生甲减的危险因素。根据全血硒水平中位值将414例孕妇分为全血硒低水平组(全血硒水平<98.28μg/L,207例)与全血硒高水平组(全血硒水平≥98.28μg/L,207例),比较2组妊娠结局。结果 414例妊娠晚期孕妇的全血硒水平为(98±14)μg/L。正常组孕妇的全血硒水平明显高于甲减组孕妇[(98±13)μg/L比(93±13)μg/L](P=0.041)。全血硒低水平组的亚临床甲减发生率与甲减总发生率均高于全血硒高水平组[9.7%(20/207)比3.4%(7/207)、12.1%(25/207)比3.9%(8/207)](均P<0.05)。多因素Logistic回归分析结果显示,年龄≥35岁、经产、孕前体重指数<18 kg/m^(2)、维生素D缺乏、全血硒低水平是妊娠晚期甲减的危险因素(均P<0.05)。全血硒低水平组的胎膜早破、流产、胎儿窘迫发生率均高于全血硒高水平组(均P<0.05)。结论 年龄≥35岁、经产、孕前体重指数<18 kg/m^(2)、维生素D缺乏、全血硒低水平是妊娠晚期甲减的危险因素,全血硒水平偏低孕妇更容易出现不良妊娠结局。

Objective To explore the relationship between the level of selenium(Se) in whole blood and hypothyroidism in the third trimester and its influence on pregnancy outcome. Methods Totally 414 women in the third trimester who underwent prenatal examination in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2019 to September 2020 were selected. According to the results of thyroid function test, the pregnant women were divided into hypothyroidism group(including clinical hypothyroidism and subclinical hypothyroidism, 33 cases) and normal group(normal thyroid function, 381 cases). The level of whole blood Se and the incidence of hypothyroidism were analyzed. The clinical data were compared between the two groups, and the risk factors of hypothyroidism in the third trimester were analyzed by multivariate Logistic regression analysis. All the pregnant women were divided into whole blood Se low level group(whole blood Se level<98.28 μg/L, 207 cases) and whole blood Se high level group(whole blood Se level≥98.28 μg/L, 207 cases) according to the median level of whole blood Se, and the pregnancy outcome of the two groups were compared. Results The level of Se in whole blood of 414 pregnant women in the third trimester was(98±14)μg/L. The level of whole blood Se in normal group was significantly higher than that in hypothyroidism group[(98±13)μg/L vs(93±13)μg/L](P=0.041). The incidence of subclinical hypothyroidism and the total incidence of hypothyroidism in whole blood Se low level group were higher than those in whole blood Se high level group[9.7%(20/207) vs 3.4%(7/207), 12.1%(25/207) vs 3.9%(8/207)](both P<0.05). Multivariate Logistic regression analysis showed that age ≥35 years, multipara, pre-pregnancy body mass index(BMI)<18 kg/m^(2), vitamin D deficiency and low level of whole blood Se were the risk factors of hypothyroidism in the third trimester(all P<0.05). The incidences of premature rupture of membranes, abortion and fetal distress in whole blood Se low level group were higher than those in whole blood Se high level group(all P<0.05). Conclusions Age≥35 years, multipara, pre-pregnancy BMI<18 kg/m^(2), vitamin D deficiency, and low level of whole blood Se are risk factors for hypothyroidism in the third trimester. Pregnant women with low level of whole blood Se are more likely to have adverse pregnancy outcome.