孕期內TPO-Ab陰性的亞甲減對初產婦妊娠和分娩結局分析

唐朝暉

[摘要] 目的 探討孕期內TPO-Ab陰性的亞甲減對初產婦妊娠和分娩結局的影響。 方法 選取2017年8月～2018年8月于我院明確診斷為亞臨床甲減的207例初產婦作為實驗對象，根據孕期分為A、B、C三組，采用化學發光免疫分析法測定血清中TSH水平，記錄并比較三組實驗對象TSH水平，并隨訪三組實驗對象的妊娠和分娩結局。結果 三組實驗對象血清中的TSH水平存在明顯差異（P<0.05）;隨訪三組的妊娠結局發現，A、B、C三組妊娠期糖尿病、胎膜早破、妊娠期貧血、產后出血及早產的發生率比較，差異有統計學意義（P<0.05），另外A、B、C三組妊娠期間發生妊娠期高血壓、前置胎盤等方面的概率無明顯差異（P>0.05）;觀察三組實驗對象胎兒情況發現，A、B、C三組的胎兒發生低出生體重及新生兒生長受限的概率，差異有統計學意義（P<0.05），而A、B、C三組胎兒發生巨大兒、胎內呼吸窘迫等方面的概率無明顯差異（P>0.05）。 結論 TPO-Ab陰性的亞臨床甲減的初產婦在不同孕期產生TSH的定量不同，從而影響產婦的妊娠結局及胎兒的情況，因此對不同孕期TSH的監測及控制對TPO-Ab陰性的亞臨床甲減初產婦的妊娠及分娩結局具有重要的意義，值得在臨床上極力推廣。

[關鍵詞] 不同孕期;亞甲減;初產婦;妊娠和分娩結局

[中圖分類號] R714.2 ? ? ? ? ?[文獻標識碼] B ? ? ? ? ?[文章編號] 1673-9701（2020）12-0064-04

[Abstract] Objective To explore the effect of TPO-Ab-negative subclinical hypothyroidism during pregnancy on pregnancy and delivery outcomes in primiparas. Methods A total of 207 primiparas who were clearly diagnosed with subclinical hypothyroidism in our hospital from August 2017 to August 2018 were selected as experimental subjects. They were divided into three groups of A， B， and C according to pregnancy terms. Chemiluminescence immunoassay was used to determine the level of TSH in serum. The TSH levels were recorded and compared between the three groups of subjects， and the pregnancy and delivery outcomes of the three groups of subjects were followed up. Results The TSH levels of the three groups of subjects were compared， and it was found that there were significant differences in the serum TSH levels between the three groups of subjects， and the differences were statistically significant（P<0.05）; During the follow-up of the pregnancy outcomes of the three groups， the incidence rates of gestational diabetes， premature rupture of membranes， anemia during pregnancy， postpartum hemorrhage and preterm birth were different between group A， group B and group C， and the differences were statistically significant（P<0.05）. In addition， there was no significant difference in the incidence rate of pregnancy-related hypertension and placenta previa during pregnancy in the three groups of A， B， and C， and the differences were not statistically significant（P>0.05）; The infants in the three groups of subjects were observed， and it was found that the incidence rates of low birth weight infant and neonatal growth restriction were different in group A， B and C， and the differences were statistically significant（P<0.05）. However，there was no significant difference in the probability of fetal giantness and intra-natal respiratory distress among the three groups of A， B， and C， and the differences were not statistically significant（P>0.05）. Conclusion The quantity of TSH produced by primiparas with TPO-Ab-negative subclinical hypothyroidism is different in different pregnancy trimesters， which affects the pregnancy outcome of the puerpera and the condition of the infants. Therefore， the monitoring and control of TSH in different pregnancy trimemsters is of great significance to the pregnancy and delivery outcomes of primiparas with TPO-Ab-negative subclinical hypothyroidism， and it is worthy of clinical promotion.

[Key words] Pregnancy trimesters; Subclinical hypothyroidism; Primiparas; Pregnancy and delivery outcomes

亞臨床甲狀腺功能減退（Subclinical hypothyroidi-sm，SCH）是一定原因引起的機體內甲狀腺激素降低，從而引起TSH升高，但是總甲狀腺激素處于正常范圍內的一類疾病，一般無明顯癥狀[1]。甲狀腺激素是人體內促進生長發育的重要激素，妊娠期由于對甲狀腺激素需求量較大，容易引起亞臨床甲狀腺功能減退，因此妊娠期合并亞臨床甲減的發病率較高[2-3]。……