亚临床甲状腺功能减退国内外诊断标准的差异及与妊娠期代谢性疾病的关系

摘要

Objective To investigate the relationship between different diagnostic criteria of subclinical hypothyroidism with metabolic diseases during pregnancy.Methods Total 911 pregnant women with normal thyroxine and negative thyroid peroxidase antibodies(TPO-Ab) were enrolled in the study.According to the standard of American Thyroid Association (ATA),pregnant women with normal serum free thyroxine whose serum TSH ＞3.0mU/L were diagnosed as subclinical hypothyroidism in pregnancy (ATA group,n=148).According to the Nation Guideline of Diagnosis and Therapy of Prenatal and Postpartum Thyroid Disease in 2012,pregnant women with serum TSH level＞5.530mU/L(upper 95％ value of our hospital) were diagnosed as subclinical hypothyroidism in pregnancy (national group,n=22),pregnant women with subclinical hypothyroidism whose serum TSH levels were between 3.0-5.530mU/L were referred as the intermediate group(n=126),and the remaining 763 cases with TSH ＜3.0mU/L served as controls.The prevalence of hypertensive disorder complicating pregnancy(HDCP),gestational diabetes mellitus(GDM) and pregnancy metabolic syndrome(GMS) were compared among the three groups and controls.The levels of TSH were also compared among HDCP,GDM,GMS and controls.Results The prevalence of subclinical hypothyroidism in national group,ATA group and intermediate group was 2.4％,16.2％ and 13.8％,respectively(all P＜0.05).The prevalence of HDCP in national group,ATA group and intermediate group were significantly higher than that in the controls(all P＜0.05).The prevalence of GDM in national group was significantly higher than controls(P＜0.05).The TSH level in HDCP patients was significantly higher than in controls(P＜0.05).Conclusion The subclinical hypothyroidism is correlated with HDCP,but not with GMS.The ATA standard of diagnosis(serum TSH level＞3.0mU/L) is safer for the antenatal care,while the national standard (serum TSH level＞5.530mU/L) is of less value for pregnancy management.%目的 研究亚临床甲状腺功能减退国内外诊断标准的差异与妊娠期代谢性疾病的关系.方法 选取甲状腺激素正常、甲状腺过氧化物酶抗体阴性的孕妇911例.按美国甲状腺学会(ATA)标准,以血清促甲状腺激素(TSH)水平＞3.0mU/L的孕妇148例为国外标准组,TSH水平≤3.0mU/L的孕妇763例为对照组.按照2012年国内制定的《妊娠和产后甲状腺疾病诊治指南》,建议各地区建立自己的孕妇TSH参考值,以本院TSH的95％上限即TSH ＞5.530mU/L的孕妇22例为国内标准组,TSH水平介于3.0～5.530mU/L的孕妇126例为中间组.比较国内标准组、国外标准组和中间组妊娠期亚临床甲状腺功能减退患病率,比较国内标准组、国外标准组、中间组与对照组妊娠期高血压疾病(HDCP)、妊娠期糖尿病(GDM)、妊娠期代谢综合征(GMS)患病率,比较TSH在HDCP、GDM、GMS 3组与正常组的高低.结果 国内标准组孕妇亚临床甲状腺功能减退患病率为2.4％,国外标准组为16.2％,中间组为13.8％,各组间比较差异均有统计学意义(均P＜0.05).国内标准组、国外标准组和中间组HDCP患病率均高于对照组,差异均有统计学意义(均P＜0.01).国内标准组与对照组GDM患病率比较,差异有统计学意义(P＜0.01).HDCP患者TSH值高于正常者,差异有统计学意义(P＜0.01).结论 妊娠期亚临床甲状腺功能减退与HDCP存在相关性,而与GMS关系不明显.按我国2012年标准诊断亚甲状腺功能减退可能过于谨慎,不利于孕期管理;按ATA标准诊断亚甲状腺功能减退对孕期管理更加安全,有利于获得更良好的妊娠结局.