【作者】 王静；

【导师】 李增彦；

【作者基本信息】 天津医科大学 ， 妇产科学（专业学位）， 2013， 硕士

【摘要】 背景：妇女妊娠期所患有的高血压病统称为妊娠期高血压疾病(hypertension disorder complicating pregnancy)。目前国外报道妊娠期高血压疾病发病率为6.4%～7.0%,子痫前期发病率约为5%,而我国妊娠期高血压疾病平均发病率为9.4%。妊娠期高血压疾病严重危及母婴健康,是孕产妇和围生儿病率及死亡率的主要原因。它对全身各系统均产生严重影响。妊娠期甲状腺疾病是近年来内分泌学界和围产医学界的热点领域之一,在国外的发病率为0.3-0.5%,而我国为1%。妊娠合体滋养细胞通过分泌HCG刺激母体甲状腺,维持孕期母体甲状腺素处于超出非孕期25%～30%的较高水平。而胎盘通过摄取母血T4在胎盘脱碘形成rT3方式为胎儿发育提供碘离子,满足胎儿神经系统发育需要,但妊娠期间母体绒毛膜促性腺激素、甲状腺激素及碘离子水平受脱碘酶的活性等多种因素的影响导致甲状腺激素的产生和代谢异常,妊娠期高血压疾病至肝肾功能损害,引起三大物质代谢的紊乱,而甲状腺激素直接参与三大物质代谢,因此甲状腺功能减低与妊娠期高血压疾病有着密切的联系。目的：本实验通过对正常足月孕妇、轻度子痫前期及重度子痫前期孕妇的甲状腺激素水平以及其产前产后甲状腺激素恢复水平进行比较,探讨妊娠期高血压疾病对甲状腺功能的影响；通过对血脂、白蛋白及尿蛋白定量与甲状腺功能的相关性分析,探讨甲状腺功能减低与三者之间的关系,从而为临床的诊治提供新的理论依据。方法：分析2011年12月至2012年12月期间,在天津医科大学总医院产科门诊产检并住院的患者200例。按照轻度子痫前期及重度子痫前期的标准进行分组：①正常组②轻度子痫前期组③重度子痫前期组,三组中排除孕前有高血压、糖尿病、心脏病、肝肾功能不全、甲亢、甲减、亚甲减、内分泌疾病史、甲状腺手术史、病历资料不全者。比较三组患者甲状腺激素水平,产前产后甲状腺激素恢复水平,血脂、白蛋白和尿蛋白定量与甲状腺功能的相关性,追踪新生儿出生后72小时足跟血的结果。结果：1.三组间甲状腺激素进行比较,随着病情加重FT3、FT4逐渐升高,TSH逐渐降低。重度子痫前期组与正常组比较最为显著,差异有统计学意义(P<0.05)。2.随着子痫前期病情的加重,TC、TG逐渐升高,重度子痫前期组明显高于正常组及轻度子痫前期组,差异有统计学意义(P<0.05)。TC、TG与TSH呈正相关(r=0.216/0.174,P<0.05)。3.患者24小时尿蛋白定量与FT3、FT4呈负相关(r=-0.353/0.168,P<0.05)。白蛋白与FT4、TSH呈正相关(r=0.166/0.190,P<0.05)。4.①正常组FT3、FT4较产前增高,但差异无统计学意义(P>0.05),而TSH较产前降低,差异有统计学意义(P<0.05)；②轻度子痫前期组FT3、FT4较产前增高,差异无统计学意义(P>0.05),而TSH较产前减低,差异有统计学意义(P<0.05)；③重度子痫前期组FT3、FT4较产前增高,TSH较产前降低,差异有统计学意义(P<0.05)。5.新生儿足跟血筛查结果正常,说明母体甲状腺功能异常对其影响不大。结论：重度子痫前期患者甲状腺激素水平降低,甲状腺激素水平的降低可进一步加重重度子痫前期的表现,这种降低可能是一种继发性改变,可能与低蛋白血症、血脂代谢紊乱相关联。重度子痫前期患者甲状腺激素水平产后的恢复时间更长,而且有一部分是甲减、亚甲减患者。妊娠期高血压患者应注意甲状腺功能的监测,对于甲减患者应及时诊断治疗,能改善妊娠期高血压疾病患者的预后。因为重度子痫前期与甲状腺功能减低在临床表现右许多的相似之处,如水肿、低蛋白血症、代谢紊乱等,因此在疾病的过程中交互影响,应注意甄别。更多还原

【Abstract】 BackgroundThe high blood pressure disease of woman when pregnancy is called hypertensive disorders in pregnancy. It is reported that the incidence of hypertensive disorders in pregnancy in foreign countries is6.4%-7.0%, the incidence of preeclampsia is5%. While in China, the average incidence of hypertensive disorders in pregnancy is9.4%.Gestational hypertension disease is seriously endangering the maternal and child health, it’s the main cause of maternal and perinatal disease rate and mortality.Thyroid disease in pregnancy is one of the key problems of internal secretion area and among the medical profession in recent years. Through secrete HCG, gestational trophoblastic irritates matrix hypothyroid, to keep the matrix hypothyroid in a high level which exceeds25%～30%than not gestation. By taking the mother blood T4in placenta iodine formed rT3to supply iodide ion for the development of fetus, meet nervous system development od fetus, but Mother during pregnancy chorionic gonadotropin, thyroid hormone and iodineion level by iodine enzyme activity of a variety of factors, such as thyroid hormone production and the degree of metabolic abnormalities. Gestational hypertension disease damaged the liver and kidney which leads to disturbance function damage of three substance metabolic,but thyroid hormone directly involved that, so the conclusion is that the thyroid function is closed with gestational hypertensive disorders.Purpose:The experiment is that through the test of FT3、FT4and TSH from normal mature pregnant woman, mild preeclampsia and severe preeclampsia,and to compare the level of thyroid hormones by prenatal and postpartum analysis the relationship between low thyroid hormone levels and hypertensive disorders in pregnancy;it’s through blood lipid, albumin and urinary protein quantitative to analyse the correlation with thyroid function, so as to provide a new theoretical basis for clinical diagnosis and treatment.Method:Analysis of Pregnant women who were outpatient obstetric and hospital birth 200cases between December2011and December2012in tianjin medical university general hospital.On the base of the standards of mild preeclampsia and severe preeclampsia divided in three groups:①normal group②Mild preeclampsia③severe preeclampsia group.Three groups have been ruled out high blood pressure, diabetes, heart disease, liver and kidney function is not complete, hyperthyroidism, thyroid function decrease,subclinical thyroid function decrease,endocrine disease history, history of thyroid surgery, medical records is not complete. Compared the patients’ thyroid hormone levels of the three groups and the level of recovery of prenatal postpartum thyroid hormones,and the relationship between blood lipid, albumin and urinary protein quantitative with thyroid function, tracked the result of the heel blood of72hours after birth.Results:1.Thyroid hormones were compared between the three groups, with the aggravation of preeclampsia,FT3, FT4were increased,and TSH was gradually reduced.The most significant was the severe preeclampsia group compared with normal group,the difference was statistically significant (P<0.05).2. As preeclampsia illness aggravating, TC and TG was increased.The severe preeclampsia group was significantly higher than that of the normal group and mild preeclampsia group, the difference was statistically significant (P<0.05). TC, TG and TSH were positively correlated (r=0.216/0.174, P<0.05).3.24-hour urine protein quantitative with FT3, FT4were negative correlation (r=-0.353/0.168, P<0.05). Albumin and FT4and TSH were positively correlated, r=0.166/0.190, P<0.05).4.①Normal group of FT3and FT4were increased compared to prenatal, but there was no statistically significant difference (P>0.05), and TSH was lower, the difference was statistically significant (P<0.05);②mild preeclampsia group of FT3, FT4were increased compared to the preenatal, there was no statistically significant difference (P>0.05), and TSH was reduced, the difference was statistically significant (P<0.05);③severe preeclampsia group of FT3, FT4was increased compared to the prenatal, TSH was lower, the difference was statistically significant (P<0.05). 5. The results of the neonatal heel blood was normal,which shows that the influence of maternal thyroid dysfunction is not important.Conclusion:The patient of severe preeclampsia’s thyroid hormone levels was lower than that of the normal patients,but the lower thyroid hormone levels can worsen the severe preeclampsia, this may be a secondary change, may be associated with hypoalbuminemia and lipid metabolic disorders.Severe preeclampsia who’s the recovery of thyroid hormone levels in postpartum patients’ time is longer, and a part of them was thyroid function decrease or subclinical thyroid function decrease.Hypertensive disorder complicating pregnancy should pay attention to monitor the thyroid function, be diagnosed and treated the thyroid function decrease in time,it will help improve the hypertensive disorder complicating pregnancy’s prognosis.Because of the severe preeclampsia and thyroid function decrease had many similarities in clinical, such as edema, hypoalbuminemia and metabolic disorders, that may be influence each other,so we should pay attention to identify.更多还原