重度子痫前期孕妇妊娠期甲减及甲状腺功能分析及对妊娠结局、围产儿影响

Analysis of the gestational hypothyroidism situation and thyroid function of pregnant women with severe preeclampsia and their influence on the pregnancy outcomes and the neonates

目的:探讨妊娠期甲减及甲状腺功能改变在重度子痫前期发病中的作用及其对妊娠结局和新生儿结局影响.方法:选择2020年1-12月本院收治的80例轻度子痫前期孕妇(MPE组)、80例重度子痫前期孕妇(SPE组),80例健康孕妇为对照组,检测孕妇甲状腺功能及甲状腺相关抗体,分析不同甲状腺功能与子痫前期严重程度的关系,并分析妊娠期甲减及甲状腺功能改变对妊娠结局及围产儿结局的影响.结果:SPE组血清促甲状腺激素(5.7±1.3 mIU/L)高于MPE组(3.5±0.9mIU/L)和对照组(3.4±0.8mIU/L),游离三碘甲状腺原氨酸(2.9±0.7pmol/L)和游离甲状腺素(9.5±1.9pmol/L)低于MPE组(4.3±0.8pmol/L、12.8±2.3pmol/L)和对照组(4.5±0.9pmol/L、13.0±2.2pmol/L),血清甲状腺过氧化物酶抗体(47.5%)和甲状腺球蛋白抗体阳性率(36.3%)高于MPE组(10.0%、6.3%)和对照组(8.8%、5.0%)(均P<0.05);胎盘早剥、早产、低出生体重等不良妊娠结局发生率,围产儿的窒息、黄疸、低血钙等不良围产儿结局发生率均高于MPE组和对照组(P<0.05).MPE组和对照组上述指标未见差异(P>0.05).结论:妊娠期甲减及甲状腺功能改变可能是导致重度子痫前期发生的危险因素之一,且会增加不良妊娠和不良围产儿结局风险.提示临床对于高危孕妇应定期监测甲状腺功能,并及时调整治疗方案,以减少并发症发生.

Objective:To investigate the role of gestational hypothyroidism and thyroid function changes of pregnant women in their severe preec lampsia occurrence.and to study their influence on the pregnancy outcomes and the neo-nates of the women.Methods:80 pregnant women with severe preeclampsia(in group A),80 pregnant women with mild preeclampsia(in group B),and 80 healthy pregnant women who underwent physical examinations(in group C)were selected as rescarch subjects from January 2020 to December 2022.The thyroid function and the thyroid related.antibodies of these women were tested.The correlation between the different thyroid functions of the women and their severity of Preeclampsia was analyzed.The influences of hypothyroidism and thyroid function changes of the women on their pregnancy outcomes and the outcomes of their perinatal infant were also analyzed.Results:The serum thyroid.stimulating hormone level(5.7±1.3 mIU/L)of the women in group A was significantly higher than that(3.5±0.9 mIU/L)of the women in group B and that(3.4±0.8 mIU/L)of the women in group C.The levels of free triodothyro-nine(2.9±0.7 pmol/L)and free thyroxine(9.5±1.9 pmol/L)of the women in group A were significantly lower than those(4.3±0.8 pmol/L and 12.8±2.3 pmol/L)of the women in group B and those(4.5±0.9 pmol/L and 13.0±2.2)of the women in group C.The positive rates of thyroid peroxidase antibody(47.5%)and thyroglobulin antibody(36.3%)of the women in group A were significantly higher than those(10.0%and 6.3%)of the women in group B and those(8.8%and 5.0%)of the women in group C(all P<0.05).The incidences of the placental abruption,the premature delivery,the low birth weight,the perinatal asphyxia,the jaundice and the bhypocalcemia of the women in group A were significantly higher than those of the women in group B and those of the women in group C(P<0.05).but which of the women had no significant different between group B and group C(P>0.05).Conclusion:The gesta-tional bhypothyroidism and the changes of thyroid function during pregnancy of the pregnant women may be one of the risk factors of their severe preeclampsia occurrence,and which can increase the risks of adverse pregnancy and perinatal infant outcomes.It is suggested that the thyroid function of the women with highrisk pregnancy should be monitored regularly and the herapeutic regimen of the women should be adjusted in time to reduce the incidence of complications.