[1]刘金金,崔世红,韩　笑,等.重度子痫前期患者甲状腺激素水平及母婴结局分析[J].新乡医学院学报,2019,36(5):459-463.[doi:10.7683/xxyxyxb.2019.05.014]
　LIU Jin-jin,CUI Shi-hong,HAN Xiao,et al.Thyroid hormone level and maternal and pregnancy outcomes in patients with severe preeclampsia[J].Journal of Xinxiang Medical University,2019,36(5):459-463.[doi:10.7683/xxyxyxb.2019.05.014]
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重度子痫前期患者甲状腺激素水平及母婴结局分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年5
页码:
459-463
栏目:
临床研究
出版日期:
2019-05-05

文章信息/Info

Title:
Thyroid hormone level and maternal and pregnancy outcomes in patients with severe preeclampsia
作者:
刘金金; 崔世红; 韩　笑; 魏天翔; 吕晓峰
（郑州大学第三附属医院产科，河南　郑州　450052）
Author(s):
LIU Jin-jin; CUI Shi-hong; HAN Xiao; WEI Tian-xiang; LYU Xiao-feng
（Department of Obstetrics，the Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，Henan Province，China）
关键词:
早发型; 晚发型; 重度子痫前期; 促甲状腺激素; 甲状腺激素; 母婴结局
Keywords:
early onset; late-onset; severe preeclampsia; thyroid stimulating hormone; thyroid hormone; pregnancy outcome
分类号:
R714.2
DOI:
10.7683/xxyxyxb.2019.05.014
文献标志码:
A
摘要:
目的　探讨早发型和晚发型重度子痫前期患者妊娠晚期甲状腺激素水平及母婴结局差异。方法　选择2017年1月至2018年1月于郑州大学第三附属医院住院分娩的重度子痫前期患者425例为研究对象，其中早发型重度子痫前期259例（早发型组），晚发型重度子痫前期166例（晚发型组）；并选同期202例非子痫前期分娩孕妇作为对照组。所有入选者均于入院次日清晨抽取空腹静脉非抗凝血，检测血清促甲状腺素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）水平，比较3组受试者甲状腺功能异常情况；并根据甲状腺功能评价结果，将重度子痫前期患者分为早发型甲状腺功能正常组、早发型甲状腺功能异常组、晚发型甲状腺功能正常组和晚发型甲状腺功能异常组，比较早发型甲状腺功能正常组与早发型甲状腺功能异常组以及晚发型甲状腺功能正常组与晚发型甲状腺功能异常组母体并发症及围产儿结局。结果　3组受试者血清TSH、FT4水平比较差异有统计学意义（χ2=60.680、39.951，P<0.05），TPOAb阳性率比较差异无统计学意义（χ2= 1.599，P>0.05）。早发型组和晚发型组患者血清TSH水平显著高于对照组（Z=-7.177、-6.071，P<0.05），血清FT4水平显著低于对照组（Z=-4.858、-5.975，P<0.05）。晚发型组与早发型组患者比较，血清TSH水平显著降低（Z=-6.071，P<0.05），FT4水平比较差异无统计学意义（Z=-1.543，P>0.05）。3组受试者甲亢/亚临床甲亢、单纯性TPOAb阳性发生率比较差异无统计学意义（χ2=0.650、0.187，P>0.05）；3组受试者甲减/亚临床甲减、低甲状腺素血症发生率以及甲状腺功能异常发生率比较差异有统计学意义（χ2= 52.841、12.912、66.766，P<0.05）。早发型组和晚发型组患者甲减/亚临床甲减、低甲状腺素血症、甲状腺功能异常发生率显著高于对照组（χ2= 53.506、9.399、64.506、26.767、12.647、38.528，P<0.05）。早发型组患者甲减/亚临床甲减发生率显著高于晚发型组 （χ2= 3.993，P<0.05），早发型组和晚发型组患者低甲状腺素血症发生率、甲状腺功能异常发生率比较差异无统计学意义（χ2=0.556、1.886，P>0.05）。早发型甲状腺功能异常组患者HELLP综合征、胎盘早剥及早产发生率与甲状腺功能正常患者比较差异无统计学意义（χ2=1.728、0.044、0.000，P>0.05）；早发型甲状腺功能异常组患者心功能不全及胎儿生长受限、新生儿窒息、围产儿死亡发生率显著高于早发型甲状腺功能正常组（χ2=4.198、6.749、5.193、6.487，P<0.05）。晚发型甲状腺功能正常组患者与晚发型甲状腺功能异常组HELLP综合征、胎盘早剥、心功能不全、早产、胎儿生长受限、新生儿窒息、围产儿死亡发生率比较差异均无统计学意义（χ2=1.739、0.227、0.713、0.945、0.004、0.043、0.713，P>0.05）。结论　重度子痫前期与妊娠晚期甲状腺功能异常密切相关，甲状腺功能异常是早发型重度子痫前期患者母婴不良结局的重要影响因素。
Abstract:
Objective　To investigate the difference of thyroid hormone level and pregnancy outcomes between the patients with early-onset and late-onset severe preeclampsia.Methods　A total of 425 patients with severe preeclampsia admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to January 2018 were selected as the study objects，including 259 cases of early-onset severe preeclampsia （early-onset group） and 166 cases of late-onset severe preeclampsia （late-onset group）.A total of 202 pregnant women without preeclampsia were selected as the control group in the same period.Non-anticoagulant fasting venous blood were taken from all the pregnant women in the next morning after admission to detect the levels of serum thyrotropin （TSH），free thyroxine （FT4） and thyroid peroxidase antibody （TPOAb），and compare the thyroid dysfunction among the three groups.The patients with severe preeclampsia were divided into early-onset normal thyroid function group，early-onset thyroid dysfunction group，late-onset normal thyroid function group and late-onset thyroid dysfunction group according to the results of thyroid function evaluation.Maternal complications and perinatal infant outcomes were compared between early-onset normal thyroid function group and early-onset thyroid dysfunction group，late-onset normal thyroid function group and late-onset thyroid dysfunction group.Results　There was significant difference in the levels of serum TSH，FT4 and the positive rate of TPOAb among the three groups （χ2=60.680，39.951，1.599；P<0.05）.The serum TSH level in the early-onset group and late-onset group was significantly higher than that in the control group （Z=-7.177，-6.071；P<0.05），and the serum FT4 level in the early-onset group and late-onset group was significantly lower than that in the control group （Z=-4.858，-5.975；P<0.05）.The serum TSH level in the late-onset group was significantly lower than that in the early-onset group （Z=-6.071，P<0.05）.There was no significant difference in serum FT4 level between the late-onset group and early-onset group （Z=-1.543，P>0.05）.There was no significant difference in the incidence of hyperthyroidism/subclinical hyperthyroidism and simple TPOAb positive among the three groups （χ2=0.650，0.187；P>0.05）.There were significant differences in the incidences of hypothyroidism/subclinical hypothyroidism，hypothyroxinemia and thyroid dysfunction among the three groups （χ2=52.841，12.912，66.766；P<0.05）.The incidences of hypothyroidism/subclinical hypothyroidism，hypothyroxinemia and thyroid dysfunction in the early-onset group and late-onset group were significantly higher than those in the control group （χ2=53.506，9.399，64.506，26.767，12.647，38.528；P<0.05）.The incidence of hypothyroidism/subclinical hypothyroidism in the early onset group was significantly higher than that in the late onset group （χ2=3.993，P<0.05）.There was no significant difference in the incidence of hypothyroidemia and thyroid dysfunction between the early-onset group and the late-onset group （χ2=0.556，1.886；P>0.05）.There was no significant difference in the incidences of HELLP syndrome，placental abruption and preterm labor between the patients with early-onset thyroid dysfunction and those with normal thyroid function （χ2=1.728，0.044，0.000；P>0.05）.The incidences of cardiac insufficiency，fetal growth restriction，neonatal asphyxia and perinatal death in the early-onset thyroid dysfunction group were significantly higher than those in the early-onset normal thyroid function group （χ2=4.198，6.749，5.193，6.487；P<0.05）.There was no significant difference in the incidence of HELLP syndrome，placental abruption，cardiac insufficiency，premature delivery，fetal growth restriction，neonatal asphyxia and perinatal death between the late-onset normal thyroid function group and the late-onset thyroid dysfunction group （χ2=1.739，0.227，0.713，0.945，0.004，0.043，0.713；P>0.05）.Conclusion　Severe preeclampsia is closely related to thyroid dysfunction in the late trimester of pregnancy.Thyroid dysfunction is an important factor for adverse pregnancy outcomes in patients with early-onset severe preeclampsia.

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更新日期/Last Update: 2019-05-05