妊娠期TPOAb、TSH水平与甲状腺功能变化的关系
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摘要
目的研究不同孕期女性血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺激素(TSH)水平变化及对甲状腺功能的影响。方法建档行常规产检的不同孕期女性1 000例作为观察组,按照不同孕期分为3组:T1期(孕周≤12周n=215)、T2期(孕周13～27周n=308)、T3期(孕周≥28周n=377),另选取同期于我院进行健康体检的女性80例为对照组。采用全自动电化学发光免疫测定仪检测血清甲状腺激素(TSH)、游离甲状腺素(FT4),采用罗氏e411电化学发光分析仪检测血清抗甲状腺过氧化物酶抗体(TPOAb),并分析TPOAb与TSH、FT4的相关性。结果观察组血清FT4水平显著低于对照组,TSH水平、TPOAb阳性率显著高于对照组,差异均有统计学意义(P<0.05);且随着孕期延长血清FT4水平、TPOAb阳性率逐渐降低,TSH水平逐渐增高,差异有统计学意义(P<0.05)。观察组TPOAb阳性孕妇血清FT4水平显著低于TPOAb阴性孕妇,TSH水平显著高于TPOAb阴性孕妇,差异有统计学意义(P<0.05)。Pearson相关分析显示,观察组TPOAb阳性孕妇血清TSH水平与TPOAb阳性率呈正相关(r=0.775,P<0.05),而血清FT4水平与TPOAb阳性率无相关性(r=0.119,P>0.05)。观察组TPOAb阳性孕妇亚临床甲减发病率显著高于TPOAb阴性孕妇,差异有统计学意义(P<0.05),而临床甲亢、亚临床甲亢、临床甲减发病率与TPOAb阴性孕妇比较差异无统计学意义(P>0.05)。观察组TPOAb阳性孕妇随着孕期延长亚临床甲减发病率逐渐增高,差异有统计学意义(P<0.05),而不同孕期临床甲亢、亚临床甲亢、临床甲减发病率比较差异无统计学意义(P>0.05)。观察组TPOAb阳性孕妇不良妊娠结局发生率显著高于TPOAb阴性孕妇,差异有统计学意义(P<0.05)。结论不同孕期女性血清TSH、TPOAb明显增高,且TPOAb阳性孕妇TSH、TPOAb呈正相关,TPOAb是导致妊娠期女性甲状腺功能异常和不良妊娠结局发病率增高的主要危险因素。
Objective To investigate the effects of the serum levels thyroid peroxidase antibody(TPOAb) and hyroid hormones(TSH) on thyroid function in pregnant women at different pregnant periods.Methods A total of 1000 pregnant women,who underwent prenatal examination in our hospital from July 2017 to July 2018,were enrolled as observation group.According to different pregnant periods,the pregnant women in observation group were redivided into group T1(≤12 weeks),group T2(13～27 weeks) and group T3(≥28 weeks).Meanwhile the other 80 women who underwent physical examination in our hospital were enrolled as control group.The serum levels of TSH and FT4 were detected by chemiluminescence enzyme immunoassay,moreover,the serum levels of TPoAb were measured by Roche electrical chemiluminescence immunoassay.And the correlation between TPOAb and TSH,FT4 and TPOAb was analyzed.Results The serum levels of FT4 in observation group were significantly lower than those in control group,however,the serum levels of TSH and TPOAb positive rate in observation group were significantly higher than those in control group(P<0.05).With the prolongation of pregnant period,the serum levels of FT4 and TPOAb positive rate were decreased gradually,however, the serum levels of FSH were increased gradually(P<0.05). In observation group the serum levels of FT4 in the pregnant women with positive TPOAb were significantly lower than those of pregnant women with negative POAb,and serum levels of TSH in the pregnant women with positive POAb were significantly lower than those of pregnant women with negative POAb(P<0.05).Pearson analysis showed that serum levels of TSH in the pregnant women with positive TPOAb in observation group were positively correlated with those of TPOAb positive rate(r=0.775,P<0.05),but there was no correlation between serum levels of FT4 and TPOAb positive rate(r=0.119,P>0.05).Moreover the incidence rate of subclinical hypothyroidism in positive TPOAb pregnant women was significantly higher than that in negative TPOAb pregnant women(P<0.05),however there were no significant differences in the incidence rates of hyperthyroidism,subclinical hyperthyroidism and clinical hypothyroidism between positive TPOAb pregnant women and negative TPOAb pregnant women(P>0.05).With the prolongation of pregnant period,The incidence rate of subclinical hypothyroidism in TPOAb positive pregnant women was increased gradually(P<0.05),but there were no significant differences in the incidence rates of hyperthyroidism,subclinical hyperthyroidism and clinical hypothyroidism among the three groups of positive TPOAb pregnant women( P > 0. 05). In addition the incidence of adverse pregnancy outcomes in TPOAb positive pregnant women was significantly higher than that in TPOAb negative pregnant women( P < 0. 05).Conclusion The levels of TSH and TPOAb in pregnant women at different pregnant periods are significantly increased,moreover the levels of serum levels of TSH in positive TPOAb pregnant women are positively correlated with those of TPOAb.TPOAb is an important risk factor for increase of incidence rtae of hypothyroidism and adverse pregnancy outcomes during pregnancy.
Objective To investigate the effects of the serum levels thyroid peroxidase antibody(TPOAb) and hyroid hormones(TSH) on thyroid function in pregnant women at different pregnant periods.Methods A total of 1000 pregnant women,who underwent prenatal examination in our hospital from July 2017 to July 2018,were enrolled as observation group.According to different pregnant periods,the pregnant women in observation group were redivided into group T1(≤12 weeks),group T2(13～27 weeks) and group T3(≥28 weeks).Meanwhile the other 80 women who underwent physical examination in our hospital were enrolled as control group.The serum levels of TSH and FT4 were detected by chemiluminescence enzyme immunoassay,moreover,the serum levels of TPoAb were measured by Roche electrical chemiluminescence immunoassay.And the correlation between TPOAb and TSH,FT4 and TPOAb was analyzed.Results The serum levels of FT4 in observation group were significantly lower than those in control group,however,the serum levels of TSH and TPOAb positive rate in observation group were significantly higher than those in control group(P<0.05).With the prolongation of pregnant period,the serum levels of FT4 and TPOAb positive rate were decreased gradually,however, the serum levels of FSH were increased gradually(P<0.05). In observation group the serum levels of FT4 in the pregnant women with positive TPOAb were significantly lower than those of pregnant women with negative POAb,and serum levels of TSH in the pregnant women with positive POAb were significantly lower than those of pregnant women with negative POAb(P<0.05).Pearson analysis showed that serum levels of TSH in the pregnant women with positive TPOAb in observation group were positively correlated with those of TPOAb positive rate(r=0.775,P<0.05),but there was no correlation between serum levels of FT4 and TPOAb positive rate(r=0.119,P>0.05).Moreover the incidence rate of subclinical hypothyroidism in positive TPOAb pregnant women was significantly higher than that in negative TPOAb pregnant women(P<0.05),however there were no significant differences in the incidence rates of hyperthyroidism,subclinical hyperthyroidism and clinical hypothyroidism between positive TPOAb pregnant women and negative TPOAb pregnant women(P>0.05).With the prolongation of pregnant period,The incidence rate of subclinical hypothyroidism in TPOAb positive pregnant women was increased gradually(P<0.05),but there were no significant differences in the incidence rates of hyperthyroidism,subclinical hyperthyroidism and clinical hypothyroidism among the three groups of positive TPOAb pregnant women( P > 0. 05). In addition the incidence of adverse pregnancy outcomes in TPOAb positive pregnant women was significantly higher than that in TPOAb negative pregnant women( P < 0. 05).Conclusion The levels of TSH and TPOAb in pregnant women at different pregnant periods are significantly increased,moreover the levels of serum levels of TSH in positive TPOAb pregnant women are positively correlated with those of TPOAb.TPOAb is an important risk factor for increase of incidence rtae of hypothyroidism and adverse pregnancy outcomes during pregnancy.
引文
1 吴美琴,王伟业,颜崇淮.妊娠期亚临床甲状腺功能减退的相关指南对比分析.现代妇产科进展,2017,26:145-148.
2 胡萍.甲状腺功能筛查在妊娠期的临床研究.现代诊断与治疗,2014,25:2260-2261.
3 Kostecka-Matyja M,Fedorowicz A,Bar-Andziak E,et al.Reference values for TSH and free thyroid hormones in healthy pregnant women in poland:a prospective,multicenter study.Eur Thyroid J,2017,6:82-88.
4 王道成,毕嘉,黄丽,等.自身免疫性甲状腺功能紊乱孕妇血清TPOAb检测的临床价值.现代生物医学进展,2016,16:3373-3375,3400.
5 Matuszek B,Zakoscielna K,Baszak-Radomanska E,et al.Universal screening as a recommendation for thyroid tests in pregnant women.Ann Agric Environ Med,2011,18:375-379.
6 武春梅,李玲,杜叶平,等.不同孕期不同年龄段孕妇甲状腺激素水平的研究分析.国际检验医学杂志,2013,34:1324-1326.
7 杜珂珂,徐峰.孕期亚临床甲状腺功能减退对子痫前期的发病及妊娠结局的影响.健康研究,2016,36:490-492.
8 Shan Z,Chen L,Lian X,et al.Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in china:a cross-sectional study in 10 Cities.Thyroid,2016,26:1125-1130.
9 Khalid AS,Joyce C,O' Donoghue K.Prevalence of subclinical and undiagnosed overt hypothyroidism in a pregnancy loss clinic.Ir Med J,2013,106:107-110.
10 杨俊娟,郭华峰,丁书贵,等.孕早期合并亚甲减及其中TPOAb阳性孕妇治疗与否对围产结局的影响.中华妇产科杂志,2015,50:652-657.
11 贺译平,贺同强,王艳霞,等.不同标准诊断的亚临床甲状腺功能减退症及甲状腺过氧化物酶抗体阳性对妊娠的影响.中华妇产科杂志,2014,49:823-828.
12 杨明辉,吴新宝,龚晓峰,等.骨科与老年科共管模式治疗老年髋部骨折及与英国的比较.中国骨与关节杂志,2017,6:169-173.
13 陈志强,周乐平.甲状腺过氧化物酶抗体在妊娠早期筛查中的临床意义.当代医学,2015,21:24-25.
14 朱小秀,高春利.不同孕期孕妇甲状腺激素水平变化及其与TPOAb的关系研究.实验与检验医学,2018,36:412-414,436.
15 Saki F,Dabbaghmanesh MH,Ghaemi SZ,et al.Thyroid autoimmunity in pregnancy and its influences on maternal and fetal outcome in Iran (a prospective study).Endocr Res,2015,40:139-145.
16 Lin L,Zhang XL,Long Y.Analysis of thyroid peroxidase antibody in early pregnancy.Genet Mol Res,2014,13:5107-5114.
17 中华医学会内分泌分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南.中华内分泌代谢杂志,2012,28:354-371.
2 胡萍.甲状腺功能筛查在妊娠期的临床研究.现代诊断与治疗,2014,25:2260-2261.
3 Kostecka-Matyja M,Fedorowicz A,Bar-Andziak E,et al.Reference values for TSH and free thyroid hormones in healthy pregnant women in poland:a prospective,multicenter study.Eur Thyroid J,2017,6:82-88.
4 王道成,毕嘉,黄丽,等.自身免疫性甲状腺功能紊乱孕妇血清TPOAb检测的临床价值.现代生物医学进展,2016,16:3373-3375,3400.
5 Matuszek B,Zakoscielna K,Baszak-Radomanska E,et al.Universal screening as a recommendation for thyroid tests in pregnant women.Ann Agric Environ Med,2011,18:375-379.
6 武春梅,李玲,杜叶平,等.不同孕期不同年龄段孕妇甲状腺激素水平的研究分析.国际检验医学杂志,2013,34:1324-1326.
7 杜珂珂,徐峰.孕期亚临床甲状腺功能减退对子痫前期的发病及妊娠结局的影响.健康研究,2016,36:490-492.
8 Shan Z,Chen L,Lian X,et al.Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in china:a cross-sectional study in 10 Cities.Thyroid,2016,26:1125-1130.
9 Khalid AS,Joyce C,O' Donoghue K.Prevalence of subclinical and undiagnosed overt hypothyroidism in a pregnancy loss clinic.Ir Med J,2013,106:107-110.
10 杨俊娟,郭华峰,丁书贵,等.孕早期合并亚甲减及其中TPOAb阳性孕妇治疗与否对围产结局的影响.中华妇产科杂志,2015,50:652-657.
11 贺译平,贺同强,王艳霞,等.不同标准诊断的亚临床甲状腺功能减退症及甲状腺过氧化物酶抗体阳性对妊娠的影响.中华妇产科杂志,2014,49:823-828.
12 杨明辉,吴新宝,龚晓峰,等.骨科与老年科共管模式治疗老年髋部骨折及与英国的比较.中国骨与关节杂志,2017,6:169-173.
13 陈志强,周乐平.甲状腺过氧化物酶抗体在妊娠早期筛查中的临床意义.当代医学,2015,21:24-25.
14 朱小秀,高春利.不同孕期孕妇甲状腺激素水平变化及其与TPOAb的关系研究.实验与检验医学,2018,36:412-414,436.
15 Saki F,Dabbaghmanesh MH,Ghaemi SZ,et al.Thyroid autoimmunity in pregnancy and its influences on maternal and fetal outcome in Iran (a prospective study).Endocr Res,2015,40:139-145.
16 Lin L,Zhang XL,Long Y.Analysis of thyroid peroxidase antibody in early pregnancy.Genet Mol Res,2014,13:5107-5114.
17 中华医学会内分泌分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南.中华内分泌代谢杂志,2012,28:354-371.