本文選題：孕晚期 + 甲狀腺過(guò)氧化物酶抗體��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)研究甲功正常伴甲狀腺過(guò)氧化物酶抗體陽(yáng)性孕婦與其新生兒甲狀腺功能的關(guān)系,探討孕晚期不同滴度TPO-Ab對(duì)后代甲狀腺功能的影響。了解過(guò)氧化物酶抗體與甲狀腺功能異常的相關(guān)性,為妊娠期甲狀腺功能篩查的必要性及干預(yù)的必要性提供理論依據(jù)。方法:選取2015年1月至2016年12月來(lái)我院就診的,除甲狀腺疾病外其他孕檢項(xiàng)目均正常的孕晚期妊娠婦女及其分娩的新生兒作為研究對(duì)象。收集孕婦的流行病資料和甲狀腺疾病篩查常用指標(biāo)資料以及新生兒的健康情況和甲狀腺疾病篩查常用指標(biāo)資料作為分析數(shù)據(jù),根據(jù)孕婦懷孕28周以后孕晚期初次查出的TPO-Ab滴度水平將所有研究對(duì)象分為三組,比較三組研究對(duì)象在甲狀腺相關(guān)指標(biāo)上的差異性,并采用logistics回歸分析影響新生兒甲減的主要危險(xiǎn)因素,分析孕婦甲狀腺抗體指標(biāo)與新生兒甲狀腺相關(guān)指標(biāo)的相關(guān)性。結(jié)果:本次研究共收集207名符合研究標(biāo)準(zhǔn)的孕婦,所有孕婦的平均TPO-Ab滴度水平為79.5±16.7IU/mL,根據(jù)其TPO-Ab滴度水平分成三組,其中正常組96人,低水平升高組78人,高水平升高組33人,三組孕婦在年齡、孕周和體質(zhì)指數(shù)上均無(wú)明顯的統(tǒng)計(jì)學(xué)差異。所有孕婦孕晚期檢測(cè)的TSH、TG-Ab、FT3和FT4平均值分別為2.2±1.4uIU/mL、50.4±25.0IU/mL、3.1±1.3pmol/L和14.1±2.9pmol/L,三組孕婦在FT3和FT4的水平上無(wú)明顯的統(tǒng)計(jì)學(xué)差異,但低水平升高組和高水平升高組孕婦的TSH水平要明顯高于正常孕婦(F=9.363,P0.001),高水平升高組孕婦的TG-Ab同樣明顯高于其他兩組(F=159.040,P0.001)。207名孕婦共成功分娩出新生兒213例,新生兒出生后的甲狀腺疾病篩查指標(biāo)中TPO-Ab、TG-Ab、TSH、FT3和FT4的平均滴度水平分別為29.9±15.7IU/mL、24.4±4.5IU/mL、3.7±2.3uIU/mL、3.6±1.6pmol/L和19.8±6.5pmol/L。根據(jù)其母親的分組將新生兒同樣歸入相應(yīng)的組別,比較后顯示高水平升高組孕婦分娩的新生兒Apgar評(píng)分和體重均明顯小于其余兩組(F=7.236,P=0.001;F=4.646,P=0.011),高水平升高組新生兒的TPO-Ab和TSH水平明顯高于對(duì)照組和低水平升高組(F=908.543,P0.001;F=100.818,P0.001),FT4明顯低于其他兩組(F=107.735,P0.001)。本研究中被診斷為甲狀腺功能減退癥的新生兒有15名,但僅有孕婦的TPO-Ab滴度水平是影響其新生兒甲狀腺功能減退的危險(xiǎn)因素(OR=1.278,P0.001)。新生兒母親TPO-Ab的滴度水平與新生兒的TG-Ab和FT3水平之間無(wú)明顯的相關(guān)性,孕婦的TPO-Ab的滴度水平與新生兒的TPO-Ab和TSH存在明顯的正相關(guān)性(r2=0.793,P0.001;r2=0.597,P0.001)。結(jié)論:孕晚期孕婦的TPO-Ab水平是影響新生兒甲狀腺功能減退的危險(xiǎn)因素,并且孕晚期孕婦TPO-Ab水平與新生兒的TPO-Ab和TSH水平存在明顯的正相關(guān)性。
[Abstract]:Objective: to study the relationship between thyroid function and thyroid function in pregnant women with thyroid peroxidase antibody positive and normal thyroid function, and to explore the effect of different titers of TPO-Ab on thyroid function of offspring in late pregnancy. To understand the correlation between peroxidase antibody and thyroid dysfunction, and to provide theoretical basis for screening thyroid function during pregnancy and the necessity of intervention. Methods: from January 2015 to December 2016, pregnant women with normal pregnancy and other pregnancy items except thyroid diseases and their newborns were selected as the research objects. Collecting epidemiological data of pregnant women and commonly used indicators for screening thyroid diseases, as well as information on the health status of newborns and common indicators for screening thyroid diseases, as analytical data, All the subjects were divided into three groups according to the TPO-Ab titer detected in the first trimester of pregnancy after 28 weeks of pregnancy, and the differences of thyroid related indexes among the three groups were compared. The main risk factors of neonatal hypothyroidism were analyzed by logistics regression analysis. Results: a total of 207 pregnant women were collected in this study. The average TPO-Ab titer of all pregnant women was 79.5 鹵16.7 IUU / mL. According to their TPO-Ab titers, they were divided into three groups: normal group (96 cases), low level group (78 cases) and high level group (33 cases). There was no significant difference in age, gestational age and BMI among the three groups. The mean values of TSH TG-Abn FT3 and FT4 in all pregnant women were 2.2 鹵1.4u / mLT = 50.4 鹵25.0U / mL and 14.1 鹵2.9pmol / L, respectively. There was no significant difference in FT3 and FT4 levels among the three groups. However, the TSH level of the pregnant women in the low and high level groups was significantly higher than that in the normal pregnant women. The TG-Ab of the pregnant women in the high level group was also higher than that in the other two groups. The average titer of TPO-Ab-TG-Ab-TSHFT3 and FT4 were 29.9 鹵15.7IUmL, 24.4 鹵4.5IUmL, 3.7 鹵2.3uIUmL + 3.6 鹵1.6pmol/L and 19.8 鹵6.5pmol / L, respectively. According to the grouping of their mothers, the newborns are similarly grouped into the corresponding groups, The results showed that the Apgar score and body weight of the newborns in the high level group were significantly lower than those in the other two groups. The levels of TPO-Ab and TSH in the high level group were significantly higher than those in the control group and the low level group. The levels of TPO-Ab and TSH in the high level group were significantly lower than those in the other two groups. In this study, 15 neonates were diagnosed with hypothyroidism, but only the TPO-Ab titer of pregnant women was the risk factor of neonatal hypothyroidism. There was no significant correlation between the titer of TPO-Ab and the levels of TG-Ab and FT3 in newborns. There was a positive correlation between the titer of TPO-Ab in pregnant women and TPO-Ab and TSH in newborns. There was a significant positive correlation between the titer of TPO-Ab and TPO-Ab and TSH in newborns. Conclusion: the level of TPO-Ab is a risk factor for neonatal hypothyroidism, and there is a significant positive correlation between the level of TPO-Ab and the levels of TPO-Ab and TSH of the newborns in the third trimester of pregnancy.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.1

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