妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析

摘要

Objective To discuss the influence of gestational hypothyroxinemia to the pregnancy outcomes and fetus development,and find the evidence of hormone replacement therapy.Methods The clinical data of 1141 gravida admitted from Nov.2014 to Oct.2015 were retrospectively analyzed,including the data of systematic antenatal examination,all the data of pregnancy,the materials of delivery,the last ultrasound examination,production status and the thyroid stimulating hormone (TSH) of the newborn etc.,to find the difference of related index.Results Of the 1141 gravida with integral data,200 had past history of thyroid disease,189 showed below normal of free thyroxine (FT4) and 752 were normal ones.The 189 gravida with normal TSH but lower FT4 were divided into group A (0-5％ lower than the normal FT4 value,n=60),group B (5％-10％ lower than the normal FT4 value,n=40) and group C (10％ and above lower than the normal FT4 value,n=89).The ones with both normal TSH and FT4 value served as control group.Compared to the control group,the higher premature delivery rate,incidence of gestational diabetes mellitus and cesarean delivery rate (P＜0.05) were found in group C,and more gravida in group B had a history of hypertension and dyslipidemia during pregnancy (P＜0.05).The cesarean delivery rate of group B and C were higher than group A.Meanwhile,the rate of group B was higher than control group (P＞0.05).At delivery,the maternal weight,BMI,diastolic pressure,and head circumference of fetus in the last ultrasound examination were higher in group C than in control group (P＜0.01),but the gestational weeks of the newborn were shorter in group C (38.55 ± 1.86 weeks) than in control group (39.14 ± 1.57 weeks,P＜0.01).The 189 gravida with lower FT4 were divided into two groups according to the thyroid peroxidase antibody (TPOAb) level.The head circumference of fetus in the last ultrasound examination was higher in TPOAb(+) group than in TPOAb(-) group (45.99 ± 62.36cm vs.33.23 ± 2.08cm,P＜0.01).Conclusions The influence of gestational hypothyroxinemia to pregnancy outcomes and fetus development cannot be ignored,especially for the pregnant women with lower FT4 value (10％ and above lower than the normal) or with positive TPOAb.It is suggested to take the thyroid function test in the early stage of pregnancy for those pregnant women mentioned above.%目的 探讨妊娠期低甲状腺素血症对妊娠结局及胎儿的影响,明确激素治疗的可行性.方法 回顾性分析2014年11月-2015年10月第二军医大学附属长海医院收治的1141例孕妇资料,包括妊娠期间及分娩时各项检查、末次超声、新生儿足跟血促甲状腺激素(TSH)值等资料,并比较不同程度低甲状腺素血症孕妇相关指标间的差异.结果 1141例孕妇中,既往有甲状腺疾病史者200例,血游离甲状腺素(FT4)低于正常值189例[依据血FT4水平低于正常值0～5％、5％～10％及10％以上,分为A(n=60)、B(n=40)、C(n=89)三组],正常对照组752例.与正常对照组比较,C组早产、妊娠期糖尿病、剖宫产率明显增高(P＜0.05),B组孕前高血压和血脂异常率也明显升高(P＜0.05).其中,B、C组剖宫产率明显高于A组,且C组明显高于正常对照组(P＜0.05).分娩时C组孕妇体重、体重指数、舒张压及末次超声胎儿头围均大于正常对照组孕妇(P＜0.01),但新生儿孕周(38.55±1.86周)小于正常对照组孕妇(39.14±1.57周,P＜0.01).189例低甲状腺素血症孕妇依据甲状腺过氧化物酶抗体(TPOAb)浓度分组后发现抗体阳性组胎儿末次超声头围明显大于阴性组(45.99±62.36 vs 33.23±2.08cm,P＜0.01).结论 不同程度的低FT4血症均会对妊娠结局及胎儿造成影响,尤其是血FT4值低于正常值10％以上或TPOAb阳性时.建议孕妇在孕早期行甲状腺功能检测.