甲状腺功能减退与孕早期自发性流产的相关性分析

doi:10.3969/j.issn.1671-7171.2022.02.021

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摘要【目的】探讨甲状腺功能减退与孕早期自发性流产的相关性。【方法】选取2018年3月至2020年3月在本院诊治的甲状腺功能减退孕妇120例(甲减组)和亚临床甲状腺功能减退孕妇120例(亚甲减组),另选取常规产检的健康孕妇120例为对照组。收集并比较所有受试者年龄、体重指数(BMI)、主动及被动吸烟与否、产次、是否经产妇等一般资料;采用免疫荧光分析法检测血清促甲状腺激素(TSH)、游离甲状腺激素(FT₄)水平及甲状腺过氧化物酶-Ab(TPO-Ab)阳性表达情况;比较三组孕妇妊娠结局;绘制受试者工作特征曲线(ROC)分析血清TSH、FT₄水平对孕早期自发性流产的诊断价值;采用多因素Logistic回归分析孕早期自发性流产的危险因素。【结果】与对照组比较,甲减组、亚甲减组患者血清TSH水平、TPO-Ab阳性率显著升高(P<0.05),FT₄水平显著降低(P<0.05);与亚甲减组比较,甲减组孕妇血清TSH水平、TPO-Ab阳性率显著升高(P<0.05),FT₄水平显著降低(P<0.05)。对照组、亚甲减组、甲减组孕妇发生孕早期自发性流产、早产、胎膜早剥、胎膜早破、产后贫血孕妇比例均依次升高(P<0.05)。甲减孕妇血清TSH、FT₄水平诊断孕早期自发性流产的AUC分别为0.786、0.779,二者联合检测AUC为0.898。TPO-Ab阳性、血清TSH水平异常升高、FT₄水平异常降低是甲减孕妇发生孕早期自发性流产的危险因素(P<0.05)。【结论】妊娠合并甲状腺功能减退会增加孕早期自发性流产风险,检测甲状腺功能相关指标有利于评估孕早期自发性流产。

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	刘娟弟
	王瑞
	何菊仙

关键词 ：妊娠初期, 甲状腺功能减退症, 流产,自然, 妊娠并发症

Abstract：【Objective】To investigate the relationship between hypothyroidism of pregnancy and spontaneous abortion in early pregnancy. 【Methods】 A total of 120 cases of hypothyroidism pregnant women in our hospital from March 2018 to March 2020 were selected as hypothyroidism group and 120 cases of subclinical hypothyroidism were selected as subclinical hypothyroidism group. In addition, 120 healthy pregnant women during the same time period were selected as the control group. The general data of all subjects were collected and compared, including age, body mass index (BMI), active and passive smoking, number of childbirth, and maternal status. The levels of serum thyroid stimulating hormone (TSH), free thyroid hormone (FT₄) and the positive expression of thyroid peroxidase-Ab (TPO-Ab) were detected by immunofluorescence analysis. The pregnancy outcomes of the three groups were compared. The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic value of serum TSH and FT₄ levels in spontaneous abortion in early pregnancy. Multivariate Logistic regression analysis was used to analyze the risk factors of spontaneous abortion in early pregnancy. 【Results】Compared with those in the control group, the serum TSH level and TPO-Ab positive rate in hypothyroidism group and subclinical hypothyroidism group were significantly higher (P<0.05), and the FT₄ level was significantly lower (P<0.05). Further compared with those in subclinical hypothyroidism group, serum TSH level and TPO-Ab positive rate in hypothyroidism group were significantly higher (P<0.05) and FT₄ level was significantly lower (P<0.05). In the order of control group, subclinical hypothyroidism group and hypothyroidism group, the proportions of pregnant women with spontaneous abortion, premature delivery, premature rupture of membranes, and postpartum anemia increased sequentially (P<0.05). The AUC of serum TSH and FT₄ levels in hypothyroidism patients for diagnosing spontaneous abortion in early pregnancy was 0.786 and 0.779, respectively, and the AUC of combined detection of TSH and FT₄ was 0.898. TPO-Ab positivity, abnormal increase of serum TSH level and abnormal decrease of FT₄ level were risk factors of spontaneous abortion in early pregnancy (P<0.05). 【Conclusion】Hypothyroidism in pregnancy may increase the risk of spontaneous abortion in early pregnancy. The detection of thyroid function related indicators is helpful to evaluate spontaneous abortion in early pregnancy.

Key words： Pregnancy Trimester,First Hypothyroidism Abortion,Spontaneous Pregnancy Complications

收稿日期: 2021-12-06

中图分类号:

R714.25

通讯作者: *E-mail:972173916@qq.com

引用本文:

刘娟弟, 王瑞, 何菊仙. 甲状腺功能减退与孕早期自发性流产的相关性分析[J]. 医学临床研究, 2022, 39(2): 232-235.
LIU Juan-di, WANG Rui, HE Ju-xian. Relationship between Hypothyroidism and Spontaneous Abortion in Early Pregnancy. JOURNAL OF CLINICAL RESEARCH, 2022, 39(2): 232-235.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.02.021 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I2/232

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