本文關(guān)鍵詞：妊娠中晚期亞臨床甲狀腺功能減退癥對母親及胎兒合并癥的影響　出處：《湖南師范大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 妊娠中晚期 亞臨床甲狀腺功能減退癥 甲狀腺過氧化物酶抗體 妊娠結(jié)局

【摘要】：目的：探討2012年中華醫(yī)學(xué)會《妊娠和產(chǎn)后甲狀腺疾病診治指南》和2011年美國甲狀腺學(xué)會(American Thyroid Association, ATA)《妊娠和產(chǎn)后甲狀腺疾病診治指南》診斷妊娠中晚期亞臨床甲減臨床應(yīng)用的合理性及妊娠中晚期亞臨床甲減對母親及胎兒合并癥的影響。 方法：收集了2011年8月至2013年2月在湖南省人民醫(yī)院產(chǎn)科病房住院分娩且在妊娠中期或者晚期檢測了甲狀腺功能、資料完整的491名孕婦的病歷資料。 1.采用2012年中華醫(yī)學(xué)會《妊娠和產(chǎn)后甲狀腺疾病診治指南》推薦的Roche試劑妊娠中晚期TSH、FT4參考值分組：亞臨床甲減組(n=9),低T4血癥組(n=46),正常對照組(n=396)； 2.采用2011年ATA《妊娠和產(chǎn)后甲狀腺疾病診治指南》推薦的妊娠中晚期TSH參考值上限3. OmIU/L分組：亞臨床甲減組(n=91,TPOAb陽性8例,TPOAb陰性83例),低T4血癥組(n=37, TPOAb陽性7例,TPOAb陰性30例),正常對照組(n=314, TPOAb陽性即單純TPOAb陽性30例,TPOAb陰性284例),其中血清0.1mIU/LTSH3.0mlU/L、FT4水平正常且TPOAb陰性組孕婦按照TSH水平進(jìn)行四分位數(shù)分組,P1組(n=70):0.19mIU/LTSH≤1.10mIU/L; P2組(n=72):1.10mIU/L TSH≤1.74mIU/L; P3組(n=72):1.74mIU/LTSH≤2.22mIU/L;P4組(n=70):2.22mIU/LTSH≤2.99mIU/L。 分析亞臨床甲減、低T4血癥、TPOAb陽性與母親及胎兒合并癥,與母親空腹血糖、血壓、體重等指標(biāo)的關(guān)系。 結(jié)果： 1.采用2012年中華醫(yī)學(xué)會《妊娠和產(chǎn)后甲狀腺疾病診治指南》推薦的Roche試劑妊娠中晚期TSH、FT4參考值分組： 與正常對照組比較,低T4血癥組BMI較大,差異有統(tǒng)計學(xué)意義(P0.05)。 2.采用2011年ATA《妊娠和產(chǎn)后甲狀腺疾病診治指南》推薦的妊娠中晚期TSH參考值上限3.OmlU/L分組： 2.1與正常對照組比較,亞臨床甲減組胎頭下降停滯、胎兒窘迫、新生兒窒息和總胎兒合并癥發(fā)生率較高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.2與正常對照組比較,低T4血癥組BMI較大,差異有統(tǒng)計學(xué)意義(P0.05)。 2.3與采用中華醫(yī)學(xué)會標(biāo)準(zhǔn)比較,采用2011年ATA標(biāo)準(zhǔn)亞臨床甲減的陽性診斷率較高,亞臨床甲減組內(nèi)胎兒窘迫、新生兒窒息、母親合并癥和胎兒合并癥的構(gòu)成比更高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.4與抗體陰性亞臨床甲減組比較,抗體陽性亞臨床甲減組胎兒窘迫的發(fā)生率較高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.5與抗體陰性低T4血癥組比較,抗體陽性低T4血癥組胎頭下降停滯的發(fā)生率較高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.6與抗體陰性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常組比較,抗體陰性亞臨床甲減組胎兒窘迫的發(fā)生率較高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.7與抗體陰性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常組比較,抗體陰性低T4血癥組BM工較大,收縮壓較高,差異有統(tǒng)計學(xué)意義(P0.05)。 2.8將抗體陰性且血清0.1mIU/LTSH3.0mIU/L、FT4水平正常組(n=284)按照TSH水平四分位分組為P1、P2、P3、P4組。上四分位組(P4組)較下四分位組(P1組)胎兒窘迫發(fā)生率增高,差異有統(tǒng)計學(xué)意義(P0.01)。 結(jié)論： 1.妊娠中晚期亞臨床甲減診斷標(biāo)準(zhǔn)中TSH下限采用2011年ATA《妊娠和產(chǎn)后甲狀腺疾病診治指南》推薦的3.OmIU/L能提高亞臨床甲減的診斷率,減少漏診,可能更合理。 2.妊娠中晚期亞臨床甲減是妊娠的高危因素,可導(dǎo)致胎兒窘迫、胎頭下降停滯、新生兒窒息、總的胎兒合并癥發(fā)生風(fēng)險增加。 3.妊娠中晚期TPOAb陽性是妊娠的高危因素,TPOAb陽性合并亞臨床甲減或低T4血癥可能導(dǎo)致胎兒合并癥的發(fā)生風(fēng)險進(jìn)一步增加。
[Abstract]:Objective: To explore the Chinese Medical Association in 2012 and the "guidelines for diagnosis and treatment of pregnancy: postpartum thyroid disease and 2011 American Thyroid Association (American Thyroid Association, ATA) < influence pregnancy and guidelines for diagnosis and management of postpartum thyroid disease diagnosis of clinical application on advanced subclinical hypothyroidism in pregnancy and in late pregnancy subclinical hypothyroidism on maternal and fetal complications.
Methods: a total of 491 pregnant women who were hospitalized in the maternity ward of Hunan People's Hospital from August 2011 to February 2013 were collected and their thyroid function was examined in the second or third trimester.
1., we used the Roche reagent recommended by the Chinese Medical Association 2012 "guidelines for diagnosis and treatment of thyroid disorders after pregnancy and postpartum". The TSH value of pregnancy was FT4 and the reference values of FT4 were: subclinical hypothyroidism group (n=9), low T4 group (n=46), normal control group (n=396).
By late 2011 2. ATA< pregnancy and postpartum guidelines for diagnosis and management of thyroid disease in pregnancy TSH > recommended limit 3. OmIU/L reference value: group subclinicalhypothyroidism group (n=91, 8 cases were TPOAb positive, 83 TPOAb negative cases), low T4 level group (n=37, 7 cases were TPOAb positive, 30 TPOAb negative cases), normal control group (n=314, TPOAb positive only 30 TPOAb positive cases, 284 cases were TPOAb negative), the serum 0.1mIU/LTSH3.0mlU/L, FT4 levels in normal and TPOAb negative pregnant women were grouped according to the four percentile of the level of TSH, P1 group (n=70): 0.19mIU/LTSH = 1.10mIU/L; P2 group (n=72): 1.10mIU/L TSH group (n=72 = 1.74mIU/L; P3): 1.74mIU/LTSH = 2.22mIU/L; P4 group (n=70): 2.22mIU/LTSH = 2.99mIU/L.
The relationship between subclinical hypothyroidism, hypothyroidism, TPOAb positive and maternal and fetal complications, and maternal fasting blood glucose, blood pressure, weight and other indexes were analyzed.
Result錛，

本文編號：1433016