亚临床甲状腺功能减退及TPOAb阳性对妊娠结局及胎儿结局的研究

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[摘要] 目的 研究妊娠期亚临床甲减及TPOAb阳性对妊娠结局及胎儿结局的影响。 方法 选择500例妊娠在我区医院门诊就诊经甲状腺功能筛查诊断为亚临床甲状腺功能减退，孕妇作为研究对象（观察组）及同期正常孕妇500例（对照组），比较两组甲状腺功能指标（TSH、FT4、TPOAb），分析妊娠结局和胎儿结局情况。 结果 （1）通过对比两组孕产妇最终妊娠结局发现，患有亚临床甲减组的孕产妇流产、早产、妊娠期高血压，胎盘早剥发生率高于正常对照组，其差异具有统计学意义（P<0.05）。（2）成功娩出的新生儿中观察组新生儿窒息、低出生体重高于对照组，差异具有统计学意义（P<0.05），而新生儿先天性甲减两组数据无明显统计学差异（P>0.05）。（3）在正常组的孕妇中其中TPOAb阳性组65例，将TPOAb阳性和阴性两组最终成功娩出的新生儿中观察得到：新生儿窒息、低出生体重及先天性甲减差异无统计学意义。（4）在正常组的孕妇中其中TPOAb阳性组65例，将TPOAb阳性和阴性两组对比两组孕产妇最终妊娠结局发现，TPOAb阳性组的孕产妇其流产率差异具有统计学意义（P<0.05），而早产、妊娠期高血压、胎盘早剥与对照组差异无统计学意义。 结论 亚临床甲状腺功能减退与流产、早产，妊娠并发症及妊娠和胎儿结局产生不良影响，而TPOAb阳性对这两种影响各异。在今后临床工作中应做好孕早期筛查，争取做到早诊断、早治疗，从而改善妊娠结局和胎儿结局。

[关键词] 亚临床甲状腺功能；妊娠；胎儿；结局；新生儿

[中图分类号] R715.9 [文献标识码] B [文章编号] 1673-9701（2016）15-0034-05

[Abstract] Objective To explore the influence of subclinical hypothyroidism and positive TPOAb on pregnancy outcomes and fetal outcomes. Methods 500 pregnant women diagnosed by thyroid function screening as subclinical hypothyroidism were selected as the observation group， and another 500 healthy pregnant women were selected as the control group. The thyroid function indexes （TSH， FT4， TPOAb） were compared between two groups， and the pregnancy outcomes and fetal outcomes were analyzed. Results 1.As to the pregnancy outcomes， the incidence rates of miscarriage， premature delivery， gestational hypertension， and placental abruption were significantly higher in the subclinical hypothyroidism group than in the control group. 2.Among newborns successfully delivered， the incidence rates of neonatal asphyxia and low birth weight were significantly higher in the observation group than in the control group（P<0.05）， while there was no significant difference in newborn congenital hypothyroidism between two groups（P>0.05）. 3.There were 65 pregnant women with positive TPOAb in the control group and there was no significant difference in neonatal asphyxia， low birth weight， and congenital hypothyroidism among newborns successfully delivered by women with positive TPOAb and those with negative TPOAb in the control group. 4.As to the pregnant outcomes in the control group， there was significant difference in rate of miscarriage between women with positive TPOAb and those with negative TPOAb（P<0.05）， while there were no significant differences in rates of premature delivery， gestational hypertension， and placental abruption. Conclusion Subclinical hypothyroidism has a negative impact on pregnancy outcomes and fetal outcomes， causing an increase in rates of miscarriage， premature delivery， and pregnancy complications， while positive TPOAb has different influences on pregnancy outcomes and fetal outcomes. First-trimester screening is essential for early diagnosis and early treatment of subclinical hypothyroidism to improve the outcomes of pregnancy and fetuses.