【摘要】：目的探討甲狀腺過氧化物酶抗體在亞甲減孕婦中的意義、激素治療對亞甲減孕婦不良妊娠事件的影響,對妊娠婦女規(guī)范甲狀腺疾病的篩查,早期診斷,早期治療,減少妊娠并發(fā)癥及不良妊娠結(jié)局的發(fā)生。方法選取2015年12月至2016年12月于大連醫(yī)科大學(xué)附屬第二醫(yī)院產(chǎn)檢及終止妊娠的孕產(chǎn)婦,根據(jù)甲狀腺功能篩選出合并亞臨床甲狀腺功能減退患者27例,回顧性分析其臨床病例資料,資料包括患者年齡、首次發(fā)現(xiàn)甲狀腺功能異常的孕周、合并TPOAb(thyroid peroxidase antibody,甲狀腺過氧化物酶抗體)的情況、治療情況及妊娠情況。使用SPSS 19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析,用spearman相關(guān)系數(shù)分別對患者的年齡與TPOAb之間的相關(guān)性、首次發(fā)現(xiàn)甲狀腺功能異常的孕周與TPOAb之間的相關(guān)性進(jìn)行分析。同時按照TPOAb的情況分為兩組,在兩組內(nèi)比較治療對于不良妊娠事件的影響。應(yīng)用卡方檢驗(yàn)分別對兩組內(nèi)不良妊娠事件的發(fā)生率進(jìn)行比較,P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.27例妊娠合并亞臨床甲狀腺功能減退患者中,TPOAb(+)的患者共14例,其中經(jīng)左旋甲狀腺素系統(tǒng)治療的患者10例,未經(jīng)治療者4例;TPOAb(-)的患者共13例,其中經(jīng)左旋甲狀腺素系統(tǒng)治療的患者10例,未經(jīng)治療者3例。Spearman相關(guān)系數(shù)分析顯示,年齡與TPOAb的相關(guān)系數(shù)為0.408,呈正相關(guān),P=0.035,具有統(tǒng)計(jì)學(xué)意義。2.27例妊娠合并亞臨床甲狀腺功能減退患者中,孕早期(孕1~13周末)診斷為亞臨床甲狀腺功能減退者21例,孕中期(孕14~27周末)診斷為亞臨床甲狀腺功能減退者2例,孕晚期(孕28~39周末)診斷為亞臨床甲狀腺功能減退者4例。Spearman相關(guān)系數(shù)分析顯示,孕周與TPOAb的相關(guān)系數(shù)為0.186,呈正相關(guān),P=0.352,不具有統(tǒng)計(jì)學(xué)意義。3.TPOAb(+)的患者中,經(jīng)甲狀腺素鈉片治療后,不良妊娠事件的發(fā)生率明顯低于未治療的患者(P0.05),差異具有統(tǒng)計(jì)學(xué)意義。TPOAb(-)的患者中,經(jīng)甲狀腺素鈉片治療與未治療者之間,不良妊娠結(jié)局的發(fā)生無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.TPOAb與患者的年齡呈正相關(guān),具有統(tǒng)計(jì)學(xué)意義。年齡越大,TPOAb出現(xiàn)的可能性越大�；颊呤状伟l(fā)現(xiàn)亞甲減的孕周與TPOAb之間未見統(tǒng)計(jì)學(xué)意義的相關(guān)性。2.妊娠期亞臨床甲狀腺功能減退患者中,TPOAb(+)的患者中,經(jīng)過甲狀腺素鈉片治療的患者比之未經(jīng)治療的患者,其不良妊娠事件的比例明顯降低。而TPOAb(-)的患者中,治療組與未治療組之間未見明顯差異。3.由于亞臨床甲狀腺功能減退的患者往往不具備典型的臨床癥狀,因此應(yīng)該對所有孕期婦女規(guī)范產(chǎn)前檢查,盡早對亞臨床甲狀腺功能減退的患者進(jìn)行診斷,根據(jù)我國指南盡早予以甲狀腺素鈉片治療,從而減少不良妊娠事件的發(fā)生。
[Abstract]:Objective to investigate the significance of thyroid peroxidase antibody in pregnant women with hypothyroidism, the effect of hormone therapy on adverse pregnancy events of hypothyroidism pregnant women, and the screening, early diagnosis and early treatment of thyroid diseases in pregnant women. To reduce the incidence of pregnancy complications and adverse pregnancy outcomes. Methods 27 women with subclinical hypothyroidism were selected from the second affiliated Hospital of Dalian Medical University from December 2015 to December 2016. The clinical data were analyzed retrospectively, including age of patients, gestational weeks in which thyroid dysfunction was found for the first time, TPOAb (thyroid peroxidase antibody, thyroid peroxidase antibody), treatment and pregnancy. SPSS 19.0 software was used to analyze the correlation between age and TPOAb with spearman correlation coefficient, and the correlation between gestational age of thyroid dysfunction and TPOAb was found for the first time. The patients were divided into two groups according to TPOAb, and the effects of treatment on adverse pregnancy events were compared between the two groups. Chi-square test was used to compare the incidence of adverse pregnancy events between the two groups. Results 1.There were 14 cases of TPOAb (-) in 27 cases of pregnancy complicated with subclinical hypothyroidism, including 10 cases treated with levothyroxine system and 13 cases with TPOAb (-) without treatment. Among them, 10 patients were treated with levothyroxine system, and 3 patients were not treated. Spearman correlation coefficient analysis showed that, The correlation coefficient between age and TPOAb was 0.408, and the positive correlation was 0.035. Among the 27 cases of pregnancy complicated with subclinical hypothyroidism, 21 cases were diagnosed as subclinical hypothyroidism at the first trimester of pregnancy. The subclinical hypothyroidism was diagnosed in 2 cases at the second trimester of pregnancy (at the end of 27 weeks of pregnancy) and in 4 cases with subclinical hypothyroidism at the late trimester (week 2839 of pregnancy). The Spearman correlation coefficient analysis showed that subclinical hypothyroidism was found in 2 cases. The correlation coefficient between gestational age and TPOAb was 0.186.A positive correlation was 0.352. The incidence of adverse pregnancy events was significantly lower than that of untreated patients (P0.05). There was no significant difference in the occurrence of adverse pregnancy outcomes between the patients treated with TPOAb (-) and those treated with thyroxine sodium tablets (P0.05). Conclusion 1.TPOAb is positively correlated with the age of the patients. The older the age, the more likely TPOAb will appear. There was no statistically significant correlation between the gestational age of hypothyroidism and TPOAb for the first time. Among the patients with subclinical hypothyroidism during pregnancy, the proportion of adverse pregnancy events in patients treated with thyroxine sodium tablets was significantly lower than that in untreated patients. However, there was no significant difference between the treatment group and the untreated group in TPOAb (-). Because subclinical hypothyroidism patients often do not have typical clinical symptoms, all pregnant women should be standardized prenatal examination, early diagnosis of subclinical hypothyroidism patients, According to our guidelines, thyroxine sodium tablets are given as early as possible, thus reducing the occurrence of adverse pregnancy events.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256

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