妊娠期甲状腺功能低下孕妇血清甲状腺过氧化物酶抗体水平变化及其临床意义

Changes and clinical significance of level of serum thyroid peroxidase antibody in pregnant women withhypothyroidism

目的:探讨妊娠期甲状腺功能低下孕妇血清甲状腺过氧化物酶抗体(TPOAb)水平变化及其临床意义。方法:抽取2020年1月至2020年12月南阳市中心医院收治的妊娠早期甲状腺功能低下孕妇94例作为甲减组,另抽取同期妊娠早期甲状腺功能正常孕妇94例作为对照组,比较两组孕妇妊娠期(早期、中期、晚期)TPOAb、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平,记录甲减组TPOAb阳性情况,分析TPOAb阳性孕妇甲状腺激素水平及妊娠结局。结果:妊娠早期、中期和晚期,甲减组TPOAb、TSH水平高于对照组,FT4水平低于对照组;随着孕期的增加,甲减组TPOAb、TSH水平逐渐升高,FT4水平逐渐降低(P<0.05)。甲减组中TPOAb阳性18例,其中妊娠早期9例,中期7例,晚期2例。TPOAb阳性孕妇TSH水平高于TPOAb阴性者(P<0.05),但其FT4水平比较差异未见统计学意义(P>0.05)。TPOAb阳性孕妇流产、早产和低体质量儿发生比例高于TPOAb阴性者(P<0.05)。结论:妊娠期甲状腺功能低下孕妇血清TPOAb水平存在异常变化,临床可通过检测血清TPOAb水平了解妊娠期甲状腺功能,并采取合理干预措施改善妊娠结局。

Objective To investigate the changes of level of serum thyroid peroxidase antibody(TPOAb)in pregnant twomen with hypothyroidism and its clinical significance.Methods A total of 94 pregnant women with hypothyroidism in the first trimester of pregnancy admitted to Nanyang Central Hospital from January 2020 to December 2020 were selected as the hypothyroid group,and 94 pregnant women with normal thyroid function in the first trimester of pregnancy during the same period were selected as the control group.The levels of TPOAb,free thyroxine(FT4)and thyroid-stimulating hormone(TSH)during pregnancy(in the first,second,and third trimesters)were compared between the two groups,the positive status of TPOAb in the hypothyroid group was recorded,and the thyroid hormone levels and pregnancy outcome of TPOAbpositive pregnant women were analyzed.ResultssIn the first,second,and third trimesters of pregnancy,the levels of TPOAb and TSH in the hypothyroid group were higher than those in the control group,and the FT4 level was lower than that in the control group.With the prolongation of pregnancy,the levels of TPOAb and TSH in the hypothyroid group gradually increased,and the level of FT4 gradually decreased(P<0.05).In the hypothyroid group,18 cases were TPOAb positive,including 9 cases in the first trimester,7 cases in the second trimester and 2 cases in the third trimester.The TSH level in TPOAb positive pregnant women was higher than that in TPOAb negative pregnant women(P<0.05),but there was no significant difference in FT4 level between TPOAb positive pregnant women and TPOAb negative pregnant womenn(P>0.05).The ratio of miscarriage,premature delivery and low birth weight neonates in TPOAb positive pregnant women were higher than those in TPOAb negative pregnant women(P<0.05).Conclusions The serum TPOAb level is abnormal in pregnant women with hypothyroidism during pregnancy.In clinical,clinicians can monitor the thyroid function during pregnancy by detecting the serum TPOAb level,and then take reasonable intervention to improve pregnancy outcomes.