补硒干预对单纯甲状腺过氧化物酶抗体阳性孕妇妊娠结局的影响

摘要

Objective To investigate the the influence of selenium treatment on pregnancy outcome in pregnant women with thyroid peroxidase autoantibodies(TPOAb). MethodsTo select the pregnant women from Department of Obstetrics and Gynecology of Chengdu Shuangliu District Maternity and Child Health Care Hospital from 2015 to 2016 who were screened for TSH,FT4 ,TPOAb at the first gynecological visit. 114 TPOAb( +) pregnant women were divided into two groups: selenium intervention group (n=56) and non-intervention group (n=58). In addition, 58 TPOAb( -) pregnant women were recruited as control group. Thyroid function and pregnancy outcome were compared and analyzed. Results ① The incidence of subclinical hypothyroidism and hypothyroidism of selenium intervention group and non-intervention group had no significant difference(P>0.05),but were higher than control group (P<0.05).② Compare with baseline, selenium intervention group and non -intervention group showed a significant reduction of TPOAb titers,and the reduction was greater in selenium intervention group (P<0.05).③Compared with control group, the morbidity of pregnancy hypertension, premature birth, low birth weight infant and aspiration syndrome didn’t show a significant difference (P>0.05), however, premature rupture of membranes, miscarriage and fetal distress were significant higher ( P <0.05). And the incidence of miscarriage in selenium intervention group was lower than non-intervention group ( P<0.05). Conclusion Selenium can reduce TPOAb titers significantly, and improve the pregnancy outcome to a certain degree.%目的 探讨补硒干预对单纯甲状腺过氧化物酶抗体(thyroid peroxidase antibodies, TPOAb)阳性孕妇妊娠结局的影响.方法 选取2015~2016年在成都市双流区妇幼保健院妇产科门诊建档、甲功正常TPOAb阳性孕妇114例,分为补硒干预组(56例)和未干预组(58例),另选同期正常产妇58例为对照组.孕期定期对各组产妇的甲状腺功能进行监测,比较各组产妇妊娠结局.结果 ① 补硒干预组产妇和未干预组产妇亚临床甲减和甲减的发生率比较,差异无统计学意义(P>0.05),但均高于对照组(P<0.05).② 补硒干预组和未干预组TPOAb滴度水平在整个孕期呈下降趋势,且干预组下降趋势比未干预组更明显( P<0.05).③ 单纯TPOAb阳性孕妇妊娠期高血压疾病、早产、低出生体重儿和吸入综合征的发生率与对照组比较差异无统计学意义(P>0.05),而胎膜早破、流产和胎儿窘迫的发生率显著增高(P<0.05);补硒干预组流产的发病率低于未干预组(P<0.05).结论 补硒干预能显著降低TPOAb滴度水平,并能在一定程度上改善不良妊娠结局.