【摘要】：目的甲狀腺疾病在生育期年齡婦女中極其常見，，而妊娠糖尿�。℅DM）近年隨著生活水平的提高也呈現(xiàn)升高趨勢。鑒于妊娠可對機(jī)體整個(gè)內(nèi)分泌系統(tǒng)帶來影響，本文旨在觀察這兩種產(chǎn)科常見內(nèi)分泌疾病之間的關(guān)系、對妊娠結(jié)局的影響以及干預(yù)治療的效果。 方法研究對象來自2012年2月-2013年11月間于上海第一人民醫(yī)院產(chǎn)科進(jìn)行產(chǎn)檢并分娩的孕婦，在孕中期開始進(jìn)行甲狀腺激素及抗體和GDM篩查，觀察甲狀腺疾病和GDM的患病率及二者之間的關(guān)系；妊娠期甲狀腺激素水平的動(dòng)態(tài)變化；孕婦合并甲狀腺疾病對妊娠并發(fā)癥及新生兒的影響；合并甲狀腺疾病的孕婦給予左旋甲狀腺素（L-T4）干預(yù)治療能否改善妊娠結(jié)局。 結(jié)果本研究共入組2113例孕婦，其中既往無甲狀腺疾病及糖尿病等相關(guān)病史的孕婦1974例。經(jīng)本次篩查發(fā)現(xiàn)甲狀腺疾病總患病率37.84%，其中以亞臨床甲狀腺功能減退最常見，為19.55%，其次為甲狀腺功能正常TPOAb陽性�；加蠫DM孕婦出現(xiàn)甲狀腺疾病者較無GDM的孕婦高（47.35%比36.37%，P=0.001）。在既無甲狀腺疾病也無GDM的正常孕婦中，妊娠期血清甲狀腺激素水平在正常范圍內(nèi)有所波動(dòng)，血清TSH水平呈上升趨勢，血清FT3、FT4水平呈下降趨勢。合并甲狀腺疾病的孕婦出現(xiàn)GDM、胎膜早破、胎兒生長受限、早產(chǎn)等的概率較正常組的孕婦高，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。其中亞臨床甲減、臨床甲減、TPOAb陽性的孕婦出現(xiàn)產(chǎn)科并發(fā)癥的風(fēng)險(xiǎn)較大，通過L-T4干預(yù)治療，可減少產(chǎn)科并發(fā)癥的發(fā)生，藥物干預(yù)可以改善血清TSH水平，但是對血清FT3、FT4水平影響無明顯。 結(jié)論本研究提示不少“正�！痹袐D在妊娠期可檢出甲狀腺疾病和GDM，在GDM孕婦中妊娠甲狀腺疾病的患病率明顯升高。正常孕婦妊娠期血清甲狀腺激素水平可在正常范圍內(nèi)波動(dòng)。孕婦甲狀腺功能異�？稍黾赢a(chǎn)科并發(fā)癥的發(fā)生率，對新生兒產(chǎn)生不利的影響，積極的藥物干預(yù)可改善妊娠結(jié)局。
[Abstract]:Objective thyroid disease is very common in women of reproductive age, and (GDM) of gestational diabetes mellitus (PDM) has been increasing with the improvement of living standard in recent years. In view of the effect of pregnancy on the whole endocrine system, the purpose of this paper is to observe the relationship between the two common endocrine diseases in obstetrics, the effect on pregnancy outcome and the effect of intervention therapy. Methods pregnant women from February 2012 to November 2013 in Shanghai first people's Hospital were screened for thyroid hormones and antibodies and GDM. The prevalence of thyroid disease and GDM and the relationship between them were observed. The dynamic changes of thyroid hormone levels during pregnancy, the influence of pregnant women with thyroid disease on pregnancy complications and newborn, and whether the pregnant women with thyroid disease can improve the outcome of pregnancy with the intervention of levothyroxine (L-T4). Results A total of 2113 pregnant women were enrolled in this study, 1974 of whom had no history of thyroid disease and diabetes mellitus. The total prevalence rate of thyroid diseases was 37.84%, among which subclinical hypothyroidism was the most common, 19.55%, followed by normal thyroid TPOAb positive. The incidence of thyroid disease in pregnant women with GDM was higher than that without GDM (47.35% vs 36.37%, P0. 001). In normal pregnant women with neither thyroid disease nor GDM, serum thyroid hormone level fluctuated within normal range, serum TSH level increased and serum FT3,FT4 level decreased. The probability of premature rupture of GDM, membranes, fetal growth restriction and premature delivery in pregnant women with thyroid disease was higher than that in normal pregnant women (P0.05). Pregnant women with subclinical hypothyroidism and TPOAb positive had a higher risk of obstetric complications. Intervention with L-T4 could reduce the incidence of obstetric complications. Drug intervention could improve serum TSH level, but it could improve serum FT3,. There was no significant effect on FT4 level. Conclusion this study suggests that many "normal" pregnant women can detect thyroid diseases during pregnancy and the prevalence of GDM, in pregnant women with GDM is significantly higher. Serum thyroid hormone levels in normal pregnant women can fluctuate within normal range. Abnormal thyroid function of pregnant women can increase the incidence of obstetric complications and have adverse effects on the newborn. Active drug intervention can improve the outcome of pregnancy.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.256

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