妊娠早期甲状腺过氧化物酶抗体和(或)甲状腺球蛋白抗体阳性与不良妊娠结局的关系

摘要

目的 探讨妊娠早期甲状腺功能正常而甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和(或)甲状腺球蛋白抗体(thyroglobulin antibodies,TgAb)阳性与不良妊娠结局的关系.方法 选取2014年10月-2016年2月在本院建档的妊娠早期甲状腺功能正常的420例孕妇作为研究对象,检测其TPOAb及TgAb,根据甲状腺自身抗体检测结果 分为TPOAb及TgAb均阳性组、单纯TPOAb阳性组、单纯TgAb阳性组、TPOAb及TgAb均阴性组,分析各组不良妊娠结局的发生率.结果420例孕妇中,单纯TPOAb阳性21例(检出率5.0%),单纯TgAb阳性25例(检出率5.95%),双抗体阳性17例(检出率4.05%);妊娠中期时临床甲减发生率TPOAb及TgAb均阳性组为11.76%,高于TPOAb及TgAb均阴性组的1.40%(P<0.05);胎膜早破发生率TPOAb及TgAb均阳性组为17.65%,高于TPOAb及TgAb均阴性组的7.84%(P<0.05),而流产、妊娠期高血压和早产的发生率各组差异无统计学意义(P>0.05);新生儿并发症发生率各组差异无统计学意义(P>0.05).结论 妊娠早期甲状腺功能正常而甲状腺自身抗体TPOAb和TgAb均阳性的孕妇在妊娠中期临床甲减发生率较高,胎膜早破的发生率较高,故在妊娠早期就应对孕妇开展TPOAb及TgAb的筛查,定期监测甲状腺功能,以减少不良妊娠的发生.%Objective To explore the association between anti-thyroid peroxidase antibody (TPOAb) /anti-thyroglobulin antibody (TgAb) and adverse pregnancy outcome in thefirst trimester.Methods Four hundred and twenty euthyroid early pregnant women who received prenatal examination from October 2014 to February 2016 were enrolled in our study. According to the TPOAb and TgAb levels, they were divided into 4 groups (TPOAb and TgAb both positive, TPOAb positive and TgAb negative, TPOAb negative and TgAb positive, TPOAb and TgAb both negative) to analyze the effect of TPOAb and TgAb levels on adverse pregnancy outcome.Results Of the 420 cases, 21 cases (5.0%) were detected as TPOAb positive and TgAb negative, 25 cases (5.95%) were TPOAb negative and TgAb positive, and 17 cases (4.05%) were TPOAb and TgAb both positive. Compared with TPOAb and TgAb both negative group, the incidences of hypothyroidism in the second-trimester and premature rupture of membranes in euthyroid early pregnant women with TPOAb and TgAb both positive were significantly higher (11.76%vs 1.4%,P<0.05; 17.65%vs 7.84%, P<0.05), while there were no significant differences in the incidences of abortion, gestational hypertension, premature birth and neonatal complications among 4 groups (P<0.05).Conclusion The incidence rates of hypothyroidism in the second-trimester and premature rupture of membranes are higher in euthroid early pregnant women with both positive TPOAb and TgAb, therefore, the detection of TPOAb and TgAb should be taken in early pregnancy, and the thyroid function should be monitored regularly, to decrease the risk of adverse pregnancy.