本文選題：妊娠期 + 甲狀腺功能��； 參考：《上海交通大學》2014年碩士論文

【摘要】：目的：建立本地區(qū)妊娠期甲狀腺功能正常參考值范圍，探討本地區(qū)妊娠中期甲狀腺疾病的發(fā)病率，新生兒甲狀腺功能狀態(tài)分析。 方法：研究對象均來上海交通大學醫(yī)學院附屬國際和平婦幼保健院產科門診。第一部分：采集2011年2月17日至6月9日就診于上海交通大學醫(yī)學院附屬國際和平婦幼保健院的正常孕婦血清樣本共693例．按孕周不同分妊娠9～13、16～20、24～28、32～34和37～40周共5組。同期采用2種檢測試劑——雅培試劑(Abbott Architect I2000)和羅氏試劑(Roche CobasElecsys600)進行TSH和FT4的檢測。根據美國臨床�；芯吭航ㄗh的甲狀腺功能檢測指標參考范圍的制定方法，將測定結果的第2.5～97.5百分位數作為各項指標的參考范圍。第二部分：回顧性分析2010年3月1日-2010年7月31日在上海交通大學醫(yī)學院附屬國際和平婦幼保健院門診首次建卡登記孕婦資料1889例，，通過問卷調查方法收集所有孕婦的背景資料,將孕婦分為高危組與低危組，孕13～28周檢測促甲狀腺激素(thyroid-stimulating hormone，TSH)、血清游離甲狀腺素(freethyroxine，F(xiàn)T4)，應用妊娠中期特異性甲狀腺功能正常參考范圍,分別對高危人群及低危人群進行妊娠中期甲狀腺功能異常患病率檢測，隨訪至分娩并對新生兒足跟血TSH進行跟蹤。 結果：妊娠期間，兩種檢測試劑盒測定的TSH值具有很好的線性相關性且變化趨勢一致，均在孕9-13周顯著低于其它妊娠時點（P0.01），而在產前（孕37-40周）顯著高于其它妊娠時點（P0.01）；Roche試劑測得的各妊娠時點的TSH水平及參考范圍均顯著高于Abbott試劑（P0.001）。兩種檢測試劑測定的孕9-13周血清FT4水平均顯著高于其它妊娠時點（P0.01）；Roche試劑測得的孕9-13周血清FT4水平顯著高于Abbott試劑，而其測得的孕24-28周和產前血清FT4數值顯著低于Abbott試劑（均P0.01）。無論是Abbott還是Roche的檢測試劑，血清TSH與FT4之間具有統(tǒng)計學意義的相關性僅出現(xiàn)于孕9-13周(雅培試劑：r=-0.319；羅氏試劑r=-0.352，P均0.001）。 高危人群占所研究人群的10.69%；如采用高危人群篩查策略，妊娠合并亞臨床甲亢將漏診87.5%（漏診14例）；妊娠期亞臨床甲減將漏診83.93%（漏診47例）；低甲狀腺素血癥將漏診89.47%（漏診17例）；單純甲狀腺自身抗體陽性將漏診88.35%（漏診91例）；高危人群中甲狀腺功能異常的檢出率與低危組相比，其差異無統(tǒng)計學意義。 在1889例妊娠中期孕婦中檢出亞臨床甲減患者56例，檢出率為2.96%（56/1889）；低T4血癥患者19例，檢出率為1.01%（19/1889）。亞臨床甲減組和低T4血癥組孕婦在貧血、胎窘、妊娠期高血壓疾病等并發(fā)癥發(fā)病率上與甲狀腺功能正常組比較無明顯差異。亞臨床甲減組及低T4血癥組新生兒足跟血TSH水平與甲狀腺功能正常組相比，其差異具無統(tǒng)計學意義（χ2=0.552；P=0.7590.05）。 結論：血清TSH最能準確反映甲狀腺功能，美國甲狀腺學會推薦的經驗性妊娠期TSH參考范圍上限不宜在國內直接采納，不同檢測試劑盒應建立各自的妊娠期甲狀腺功能參考范圍。對于妊娠中期孕婦進行普遍篩查能夠降低妊娠中期甲狀腺功能異常的漏診率。我們推薦在妊娠中期對甲狀腺功能進行普遍篩查。亞臨床甲減及低T4血癥孕婦在妊娠合并貧血、胎窘、妊娠期高血壓疾病發(fā)生率上與正常孕婦相比差異無顯著性；妊娠合并亞臨床甲減對新生兒甲狀腺功能無明顯不利影響。
[Abstract]:Objective: to establish the range of normal reference value of thyroid function during pregnancy, to explore the incidence of thyroid disease in the mid-term pregnancy, and to analyze the thyroid function status of the newborn.
Methods: the subjects were all taken to the Department of Obstetrics and Gynecology of the affiliated International Peace Maternity and child health care hospital of Shanghai Jiaotong University School of Medicine. Part 1: 693 cases of normal pregnant women from February 17, 2011 to June 9th were collected from the affiliated International Peace Maternity and child health care hospital of Shanghai Jiaotong University School of Medicine. According to the different pregnancy weeks, the pregnancy was divided into 9 ~ 13,16 ~ 13,16 There were 5 groups in 28,32 to 34 and 37~40 weeks. 2 testing reagents (Abbott Architect I2000) and Roche reagent (Roche CobasElecsys600) were used to detect TSH and FT4 in the same period. According to the method of formulating the reference frame of the thyroid function test index proposed by the American Institute of clinical bovine research, the results were determined from 2.5 to 9 thousand and 750. The second part: the second part: a retrospective analysis of 1889 cases of the first registration of pregnant women in the outpatient clinic of the International Peace Maternity and child health care hospital affiliated to Shanghai Jiaotong University School of Medicine in July 31st March 1, 2010. The background data of all pregnant women were collected by questionnaire, and the pregnant women were divided into high risk groups and the pregnant women were divided into high risk groups. In the low risk group, the thyroid hormone (thyroid-stimulating hormone, TSH), serum free thyroxine (freethyroxine, FT4) were detected at 13~28 weeks of pregnancy, and the normal range of normal thyroid function was used in the middle pregnancy. The TSH of the heel blood of the newborn was tracked.
Results: during pregnancy, the TSH value of the two detection kits had a good linear correlation and a consistent change trend, which was significantly lower than other pregnancy time points (P0.01) at 9-13 weeks of pregnancy (37-40 weeks of pregnancy) and significantly higher than other pregnancy time points (P0.01), and the TSH level and reference range of each pregnancy point measured by Roche test agent were both significant. The level of serum FT4 was higher than that of the Abbott reagent (P0.001). The level of serum FT4 in the 9-13 weeks of pregnancy measured by two kinds of test reagents was significantly higher than that of other pregnancy time points (P0.01), and the serum FT4 level of 9-13 weeks of pregnancy measured by Roche reagent was significantly higher than that of Abbott reagent, and the serum FT4 value measured by the reagent was significantly lower than that of Abbott reagent (P0.01). It was a test reagent for Roche. The correlation between serum TSH and FT4 was statistically significant only at 9-13 weeks of pregnancy (Abbott reagent: r=-0.319; Roche reagent r=-0.352, P 0.001).
High risk population accounted for 10.69% of the study population; if the high-risk group screening strategy, pregnancy combined with subclinical hyperthyroidism will leak 87.5% (14 cases); subclinical hypothyroidism in pregnancy will be 83.93% (47 cases); hypothyroidemia will leak diagnosis of 89.47% (17 cases); simple thyroid autoantibody positive 88.35% (91 missed diagnosis) There was no significant difference in the detection rate of thyroid dysfunction between high-risk group and low risk group.
In 1889 midtrimester pregnant women, 56 cases of subclinical hypothyroidism were detected, the detection rate was 2.96% (56/1889), and 19 cases with low T4 were 1.01% (19/1889). The incidence of complications such as anemia, fetal distress and pregnancy induced hypertension in subclinical hypothyroidism and hypothyroidism group was not significantly different from that of normal thyroid function group. The difference in the TSH level of heel blood of the subclinical hypothyroidism group and the hypothyroidemia group was not statistically significant compared with the normal thyroid function group (x 2=0.552, P=0.7590.05).
Conclusion: serum TSH is the most accurate reflection of thyroid function. The upper limit of TSH reference range of empirical pregnancy recommended by the American Thyroid Association should not be adopted directly in China. Different detection kits should establish their respective reference range of thyroid function during pregnancy. We recommend a universal screening of thyroid function in the middle of pregnancy. There is no significant difference in the incidence of pregnancy associated anemia, fetal distress, and pregnancy induced hypertension in pregnant women with subclinical hypothyroidism and hypothyroidism than in normal pregnant women; pregnancy combined subclinical hypothyroidism has no obvious thyroid function in newborns. Adverse effects.
【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.256

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