弥漫性毒性甲状腺肿病孕妇血清促甲状腺激素受体抗体水平对新生儿甲亢的影响

摘要

Objective: To investigate the influnce of serum levels of TSH receptor antibody (TRAb) in pregnant women with Graves' disease on neonatal hyperthyroidism.Methods: The clinical data of 68 pregnant women with Graves' disease and their newborns were analyzed retrospectively.The indicators included thyroid function tests and TRAb levels during pregnancy, at delivery and within 2 weeks after birth.The serum TRAb and T3, T4, FT3, FT4, TSH levels were detected by radio receptor assay (RRA) and electrical chemiluminescence immunoassay (ECLIA) respectively.Results: The results showed that maternal serum TRAb levels in the third trimester of pregnancy were positively correlated with those of the umbilical vein (n=68, r=0.8494, P＜0.01), and those of the newborns (n=68, r=0.8286, P＜0.01).The incidence of neonatal hyperthyroidism was 11.8％ (8/68).Within 2 weeks after birth, the serum TRAb levels in the 8 neonates with hyperthyroidism were three times higher than those in the normal neonates.Among eight neonates, two had the serum TRAb levels 15 times higher than those of normal neonates within 2 weeks after birth, and their thyroid function and TRAb levels were still abnormal 6 months later.Conclusions: The risk of hyperthyroidism in newborns whose mother had high TRAb levels in the third trimester of pregnancy was increased.This study showed a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.%目的 探讨弥漫性毒性甲状腺肿(Graves)病孕妇妊娠期间血清促甲状腺激素受体抗体(TRAb)水平对新生儿甲亢的影响.方法 选取2002年6月至2008年6月在北京协和医院就诊的68例Graves病孕妇及其新生儿,应用放射性受体法(RRA)和电化学发光免疫法(ECLIA)分别检测孕妇妊娠期间血清、脐血及新生儿出生5～14 d的血清T3、T4、FT3、FT4、促甲状腺激素(TSH)及TRAb水平.结果 妊娠晚期孕妇血清TRAb与脐静脉血TRAb呈正相关(n=68,r=0.8494,P<0.01),与新生儿血清TRAb也呈正相关(n=68,r=0.8286,P<0.01).新生儿甲亢的发生率为11.8%(8/68),8例甲亢新生儿出生后两周内血清TRAb均高于正常3倍以上;其中2例新生儿出生后(7～14 d)血清TRAb水平高于正常15倍以上,出生6个月时,其甲状腺功能及血清TRAb水平仍未恢复正常状态.结论 妊娠晚期血清TRAb水平增高是发生新生儿甲亢的一个危险因素.孕妇血清TRAb水平与新生儿甲亢的严重程度有一定的关系.