T_(3)/rT_(3)对妊娠高血压类疾病的早期诊断价值研究

Early diagnostic value of T_(3)/rT_(3) in hypertensive disorders during pregnancy

目的探讨甲状腺功能相关血液学指标与妊娠高血压类疾病诊断及严重程度的关系,为此类疾病早期诊断及预防提供参考。方法选取2017年2月至2019年9月来该院就诊的正常妊娠期妇女85例,妊娠期高血压87例,轻度子痫前期33例,重度子痫前期36例,采用化学发光法检测4组在妊娠12周血清中的促甲状腺激素(TSH)、总甲状腺素(TT_(4))、游离甲状腺素(FT_(4))、总三碘甲状腺原氨酸(TT_(3))、游离三碘甲腺原氨酸(FT_(3))、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)、促甲状腺激素受体抗体(TRAb)和血清反三碘甲腺原氨酸(rT_(3))水平;采用受试者工作特征(ROC)曲线分析有差异指标对妊娠高血压类疾病的诊断价值,并与24 h蛋白尿,收缩压,舒张压进行相关性分析,多因素Logistic回归分析妊娠高血压疾病发病的影响因素,各个指标效应大小用森林图显示。结果正常妊娠组rT_(3)水平显著低于其他3组,差异有统计学意义(P<0.01),T_(3)/rT_(3)显著高于其他3组,差异有统计学意义(P<0.01)。Pearson相关分析结果显示,T_(3)/rT_(3)与收缩压呈负相关(r=-0.278,P<0.01),与舒张压呈负相关(r=-0.325,P<0.01),与24蛋白尿无显著相关性。ROC曲线的评估结果显示,预测子痫前期T_(3)/rT_(3)的临界值为2.416,曲线下面积0.7200,灵敏度为0.5652,特异度为0.8235;妊娠高血压预测T_(3)/rT_(3)的临界值为2.625,曲线下面积:0.7393,灵敏度0.8721,特异度0.5059。多因素Logistic回归模型分析显示T_(3)/rT_(3)是妊娠高血压早期诊断的独立预测因子。结论妊娠期妇女T_(3)/rT_(3)可能是在妊娠高血压疾病早期诊断有价值的生物标志物。

Objective To survey the relation between thyroid function-related hematological indicators and the diagnosis and severity of pregnancy-induced hypertensive disorders,for providing references for the early diagnosis and prevention of such diseases.Methods In this study,a total of 156 hypertensive patients in 3 subgroups(87 gestational hypertension,33 mild preeclampsia,36 severe preeclampsia)and 85 healthy pregnancy ones between February 2017 and September 2019 were included.Their venous blood samples were collected using chemiluminescence method and thyroid-stimulating hormone(TSH),Total thyroxine(TT_(4)),free thyroxine(FT_(4)),total triiodothyronine(TT_(3)),free triiodothyronine(FT_(3))and anti-thyroid peroxidase antibody(TPOAb),anti-thyroglobulin antibody(TGAb),thyroid-stimulating hormone receptor antibody(TRAb)and serum trans-triiodothyronine(rT_(3))in the serum of four groups at 12 weeks of pregnancy were measured.A receiver operating curve(ROC)was generated to analyze the diagnostic value of differential indicators for pregnancy-induced hypertension,and correlation analysis were performed with 24-hour proteinuria,systolic blood pressure,and diastolic blood pressure.Multivariate regression analysis was used to influencing factors of pregnancy-induced hypertension and the result was showed with forest map.Results The rT_(3) level in the normal pregnancy group was significantly lower than the other three groups,the difference was statistically significant(P<0.01),and the T_(3)/rT_(3) level was significantly higher than the other three groups,the difference was statistically significant(P<0.01).The results of Pearson correlation analysis showed that T_(3)/rT_(3) was negatively correlated with systolic blood pressure,the difference was statistically significant(r=-0.278,P<0.01),negatively correlated with diastolic blood pressure,the difference was statistically significant(r=-0.325,P<0.01),and had no significant correlation with 24 proteinuria.The evaluation result of the ROC curve showed that the cutoff value for predicting T_(3)/rT_(3) in preeclampsia was 2.416,and the area under the curve was 0.7200,with the sensitivity 0.5652 and the specificity 0.8235.The cutoff value for predicting T_(3)/rT_(3) in pregnancy-induced hypertension was 2.625,and the area under the curve was 0.7393 with the sensitivity 0.8721 and the specificity 0.5059.Multivariate logistic regression analysis showed that T_(3)/rT_(3) was an independent predictor of early diagnosis of hypertension in pregnancy(Adjusted OR=0.077(0.007-0.89),P=0.04).Conclusion T_(3)/rT_(3) in pregnant women may be a valuable biomarker for the early diagnosis of hypertension in pregnancy.