孕早期甲状腺功能筛查对妊娠合并亚临床甲状腺功能减退的应用价值研究

摘要

目的：观察妊娠妇女孕早期甲状腺功能异常的发病率，探讨孕早期进行甲状腺功能筛查的意义．方法随机选择来丽江市人民医院产科门诊做产检的孕妇630例，在常规产检的同时做甲功5项筛查．对检测结果统计分析，对甲减、亚临床甲状腺功能减退（亚甲减）的61例孕妇追踪其治疗情况及不良妊娠结局，探讨甲减、亚甲减与不良妊娠结局的相关性．结果630例孕妇中，检出甲亢8例，患病率1.3%，甲减、亚甲减61例，发病率9.7%，其中甲减5例，患病率0.8%，亚甲减56例，患病率8.9%．甲减组TSH、FT4与正常对照组相比差异有统计学意义（＜0.01），亚甲减组TSH、FT4、TT4与正常对照组相比差异有统计学意义（＜0.05）．61例甲减、亚甲减组中有39人接受左甲状腺素治疗，22人未接受治疗．接受治疗组不良妊娠结局发生率显著低于未接受治疗组（＜0.05）．结论孕早期6～20周孕妇进行甲功检测，对及时发现妊娠期甲状腺功能异常有重要意义，应作为孕妇常规产检项目．%Objective To investigate the incidence of abnormal thyroid function in pregnant women and explore the significance of thyroid function screening in early pregnancy. Methods We randomly selected 630 cases of pregnant women who received routine inspection in the obstetric clinic in our hospital, and gave them five items of thyroid function screening besides routine check at the same time. Then we statistically analyzed the test results, and followed up 61 cases of pregnant women with hypothyroidism or subclinical thyroid function (hypothyroidism) to learn the treatment and adverse pregnancy outcomes,so as tto explore the correlation between hypothyroidism, subclinical hypothyroidism and adverse pregnancy outcomes. Results In 630 cases of pregnant women,there were 8 cases of hyperthyroidism (1.3%),61 cases of hypothyroidism or subclinical hypothyroidism (9.7%),including 5 cases of hypothyroidism (0.8%), 56 cases of subclinical hypothyroidism (8.9%) .There was statistically significant difference in TSH and FT4 between hypothyroidism group and normal control group ( <0.01) .There was statistically significant difference in TSH,FT4 and TT4 between subclinical hypothyroidism group and normal control group ( <0.05) . In 61 cases of hypothyroidism and subclinical hypothyroidism, 39 patients received levothyroxine therapy,22 received no treatment. The incidence of adverse pregnancy outcomes in the treatment group was significantly lower than the untreated group ( <0.05) . Conclusion Thyroid function testing in 6-20 weeks in early pregnancy has important significance in timely founding gestational thyroid dysfunction, so it should be as routine examination project.