【作者】 张丽；

【导师】 孟金来；

【作者基本信息】 山东大学 ， 妇产科学（专业学位）， 2018， 硕士

【摘要】 目的:本研究通过分析妊娠合并亚临床甲状腺功能减退(Subclinical hypothyroidism,SCH)以及抗甲状腺过氧化物酶抗体(Thyroid peroxidase antibody,TPOAb)与围产结局的关系,并观察亚临床甲状腺功能减退干预治疗的临床效果,旨在分析妊娠期合并亚临床甲状腺功能减退及其干预对围产结局的影响,以便进一步指导妊娠合并亚临床甲状腺功能减退孕妇的临床治疗,降低母儿相关并发症的发生率,改善围产结局。方法:收集2016年7月-2017年6月妊娠早期(6-12周)在济南市妇幼保健院查体并在该院流产或分娩的835名SCH孕妇,根据促甲状腺素(Thyroid stimulating hormone,TSH)值将其分成 A 组 163 例(TSH 4.0-10.0 mlU/L)和 B 组 672 例(TSH 2.5-4.0 mlU/L),同时随机抽取同期就诊的221名甲状腺功能正常孕妇(TSH0.1-2.5mlU/L)作为对照C组。统计孕妇一般情况(年龄、孕产次、不良孕史、学历等)、孕早期的甲状腺功能指标(TSH、FT4及TPOAb)、是否接受治疗以及围产结局(流产、早产、GDM、贫血、胎膜早破、妊娠期高血压疾病、胎盘早剥、产后出血、小于胎龄儿等信息)。采用SPSS 20.0软件对数据进行统计,分析不同情况下SCH及其治疗对围产结局的影响。结果:1、甲状腺功能与TPOAb的关系:SCH孕妇A组TPOAb阳性率为30.06%(49/163),B 组 TPOAb 阳性率为 17.56%(118/672),正常孕妇 C 组 TPOAb阳性率为6.33%(14/221)。比较各组TPOAb阳性的发生率有显著性差异(P<0.05)。2、SCH对围产结局的影响:A组和B组的贫血、流产、早产、妊娠期高血压疾病和小于胎龄儿的发生率均高于C组(P<0.05)。3、TPOAb与围产结局的关系:TPOAb阳性组与TPOAb阴性组比较,流产、早产、妊娠期高血压疾病和小于胎龄儿的发生率增加(P<0.05)。4、SCH干预治疗与围产结局的关系:SCH未治疗组孕妇贫血、流产、早产、GDM、妊娠期高血压疾病、和小于胎龄儿的发生率高于治疗组(P<0.05)。5、TPOAb阳性干预治疗与围产结局的关系:SCH合并TPOAb阳性未治疗组孕妇贫血、流产、早产、胎膜早破、GDM、妊娠期高血压疾病和小于胎龄儿的发生率高于治疗组(P<0.05),但是B组SCH合并TPOAb阴性未治疗组与TPOAb阴性治疗组比较,不良围产结局无统计学差异。结论:1、TPOAb阳性与妊娠期甲状腺功能异常相关。2、妊娠早期合并SCH可增加孕妇流产、早产、妊娠期高血压疾病、贫血和小于胎龄儿不良结局的发生。3、TPOAb阳性可能对围产结局产生不良影响。4、对于SCH孕妇甲状腺激素干预治疗是对围产结局的保护因素。5、对于TPOAb阳性的SCH孕妇,建议进行适当甲状腺激素干预治疗,以降低妊娠不良结局的发生;但对于TSH值在2.5-4.0 mlU/L之间的TPOAb阴性孕妇,可以不进行干预治疗。更多还原

【Abstract】 Objective:This study analyzed the effects of subclinical hypothyroidism(SCH)and anti-thyroid peroxidase antibody(TPOAb)on perinatal outcomes,observed the clinical efficacy of interventions for subclinical hypothyroidismand and aims to analyze the relationship between subclinical hypothyroidism.during pregnancy as well as its intervention and pregnancy outcomes,to guide the clinical treatment of pregnant women with subclinical hypothyroidism further and reduce the incidence of maternal and fetal diseases,so that the perinatal outcome can be improved.Methods:A total of 835 pregnant women in early pregnancy(6-12 weeks)with SCH who undergone physical examination in Jinan Maternal and Child Health Hospital from July 2016 to June 2017 and had miscarriage or delivery in this hospital were divided into two groups according to the thyroid stimulating hormone(TSH)value:163 pregnant women in group A(TSH 4.0-10.0 mIU/L)and 672 pregnant women in group B(TSH 2.5-4.0 mIU/L).Normal pregnant women(TSH 0.1-2.5 mIU/L)served as control group C.Statistics of pregnant women’s general conditions(age,parity,adverse pregnancy history,educational background,etc.),thyroid function indicators(TSH,FT4 and TPOAb)in early pregnancy,treatment and perinatal outcomes(abortion,premature delivery,GDM,anemia,premature rupture of membranes,hypertensive disorders during pregnancy,placental abruption Postpartum hemorrhage,small gestational age and other information).SPSS 20.0 software was used to analyze the effect of SCH and its treatment on perinatal outcome.Result:1.The relationship between thyroid function and TPOAb:The positive rate of TPOAb was 20.0%(167/835)in SCH pregnant women,30.06%(49/163)in group A,17.56%(118/672)in group B and 6.33%(14/221)in group C.The incidence of TPOAb positive in each group was compared,and the incidence of TPOAb positive in each group was significantlydifferent(P<0.05).2.Effect of SCH on perinatal outcomes:The incidence of anemia,abortion,preterm delivery,hypertensive disorders during pregnancy and infants younger than gestational age in group A and group B were higher than those in group C(P<0.05).3.Relationship between TPOAb and perinatal outcomes:The incidence of abortion,preterm delivery,hypertensive disorders of pregnancy and small gestational age infants was significantly higher in TPOAb positive group than in TPOAb negative group(P<0.05).4.The relationship between SCH intervention therapy and perinatal outcomes:The incidence of anemia,abortion,preterm delivery,GDM,hypertensive disorders of pregnancy and infants with less than gestational age in SCH untreatment group was higher than that in SCH treatment group(P<0.05);5.The relationship between TPOAb positive intervention therapy and perinatal outcomes:The incidence of anemia,abortion,preterm delivery,premature rupture of membranes,GDM,hypertensive disorders of pregnancy,and infants with less than gestational age in SCH combined with TPOAb positive untreatment group was higher than that in treatment group(P<0.05);But when SCH combined with TPOAb negative untreatment group was compared with TPOAb negative treatment group in group B,there was no statistical difference in adverse pregnancy outcomes.Conclusion:1.TPOAb positive is associated with thyroid dysfunction during pregnancy.2.SCH in early pregnancy can increase the incidence of perinatal adverse outcomes such as abortion,premature delivery,hypertensive disorders during pregnancy,anemia and infants younger than gestational age.3.TPOAb positive may have adverse effects on perinatal outcomes.4.For pregnant SCH women,thyroid hormone intervention therapy is protective for perinatal outcomes.5.For pregnant women of SCH combined with TPOAb positive,appropriate thyroid hormone interventions are recommended to reduce the incidence of adverse pregnancy outcomes;for pregnant women of TPOAb negative with TSH 2.5-4.0 mlU/L however,interventions are not necessary.更多还原