不同诊断标准下亚临床甲状腺功能减退症发病率及对妊娠结局的影响
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摘要
目的研究亚临床甲状腺功能减退国内外诊断标准的差异与不良妊娠结局的关系,评价国内诊断标准在孕期亚临床甲状腺功能减退的适宜性。方法 2016年1月至2016年8月在淄博市妇幼保健院产科门诊建档的孕妇,共计2155例。按照2012年国内制定的《妊娠和产后甲状腺疾病诊治指南》标准,建立本淄博地区不同孕期促甲状腺激素(TSH)参考范围,以本院TSH的95%上限即TSH>5.360mIU/L、血清游离甲状腺素(FT4)水平正常的妊娠合并亚甲减孕妇为国内标准组,分别与2011年、2017年美国甲状腺学会(ATA)推荐诊断标准比较,分析对妊娠期亚甲减发病率的影响,同时探讨不同诊断标准对妊娠结局的影响。结果 (1)国外旧标准组亚甲减孕妇共350例,发生率为16.24%(350/2155),国内标准组亚甲减孕妇共52例,发生率为2.41%(52/2155)。两组亚甲减发生率比较,差异有统计学意义(P<0.01);国外新标准组亚甲减孕妇共73例,发生率为3.39%(73/2155)。与国内标准组比较,差异无统计学意义(P>0.05)。(2)国内标准组、国外旧标准组、国外新标准组亚甲减孕妇的不良妊娠发生率分别与正常对照组比较,国外旧标准组差异无统计学意义(P>0.05),国内标准组、国外新标准组差异有统计学意义(P<0.01)。结论 (1)妊娠期孕妇亚甲减患病率较高,且可导致不良妊娠结局增加;(2)按我国2012年标准,采用本地区参考区间为诊断标准(血清TSH水平>5.360mIU/L)更适合本地区的地域特点,也符合2017年新国际诊断标准,避免过度治疗,可以减少不良妊娠结局的发生;按旧国际诊断标准(孕早期血清TSH水平>2.5mIU/L,中晚期>3.0mIU/L)诊断亚甲减对孕期管理过于宽泛,增加患者的经济负担和心理压力,不利于孕期管理。
Objective To study the relationship between the differences of the diagnostic criteria at home and abroad in subclinical hypothyroidism and the adverse pregnancy outcome,and to evaluate the suitability of the domestic diagnostic criteria for subclinical hypothyroidism during pregnancy.Methods From January 2016 to August 2016,a total of2155 pregnant women were registered in obstetrics and gynecology clinic of Zibo maternal and child health care hospital.According to the "guidelines for the diagnosis and treatment of pregnancy and postpartum thyroid diseases"in2012,the reference range of thyroid stimulating hormone(TSH)in different pregnancy periods in Zibo is establish.With the 95% upper limit of TSH,TSH>5.360 mIU/L,and normal serum FT4,and Pregnant women with subhypothyroidism as the domestic standard group,compared with the recommended diagnostic criteria of the American Thyroid Society(ATA)in 2011 and 2017 respectively,the influence of the incidence of hypothyroidism in pregnancy was analyzed,and the effect of pregnancy outcome under the different diagnostic criteria were also discussed.Results(1)There were 350 cases of pregnant women with subhypothyroidism in old foreign standard group,the incidence rate was16.24%(350/2155)and 52 cases of pregnant women with subhypothyroidism in the domestic standard group,the incidence rate was 2.41%(52/2155).The incidence of subhypothyroidism in the two groups was statistically significant(P<0.01);There were 73 cases of pregnant women with subhypothyroidism in the new foreign standard group were3.39%(73/2155)and in the domestic standard group,with an incidence of 2.41%(52/2155).There was no significant difference in the incidence of hypothyroidism between the two groups(P>0.05).(2)The incidence of pregnant women in the domestic standard group,the old foreign standard group and the foreign new standard group was compared with the normal control group,and the difference of the old standard group abroad was not statistically significant(P>0.05),the difference between the domestic standard group and the foreign new standard group was statistically significant(P<0.01).Conclusion(1)The prevalence of subhypothyroidism in the early pregnancy was higher and the adverse pregnancy outcome could be increased;(2)According to the standard of our country in 2012,using the local reference interval as the diagnostic standard(serum TSH level>5.360 mIU/L)is more suitable for local regional characteristics,and also conforms to the new international diagnostic standard in 2017.Avoid excessive treatment and reduce the occurrence of bad pregnancy outcome.According to the old international diagnostic standard(serum TSH level>2.5 mIU/L in the early pregnancy,>3.0 mIU/L in the middle and late stages),the diagnosis of subsubtract is too board for pregnancy management,increases the economic burden and psychological pressure of the patients,and is not conducive to the management of pregnancy.
Objective To study the relationship between the differences of the diagnostic criteria at home and abroad in subclinical hypothyroidism and the adverse pregnancy outcome,and to evaluate the suitability of the domestic diagnostic criteria for subclinical hypothyroidism during pregnancy.Methods From January 2016 to August 2016,a total of2155 pregnant women were registered in obstetrics and gynecology clinic of Zibo maternal and child health care hospital.According to the "guidelines for the diagnosis and treatment of pregnancy and postpartum thyroid diseases"in2012,the reference range of thyroid stimulating hormone(TSH)in different pregnancy periods in Zibo is establish.With the 95% upper limit of TSH,TSH>5.360 mIU/L,and normal serum FT4,and Pregnant women with subhypothyroidism as the domestic standard group,compared with the recommended diagnostic criteria of the American Thyroid Society(ATA)in 2011 and 2017 respectively,the influence of the incidence of hypothyroidism in pregnancy was analyzed,and the effect of pregnancy outcome under the different diagnostic criteria were also discussed.Results(1)There were 350 cases of pregnant women with subhypothyroidism in old foreign standard group,the incidence rate was16.24%(350/2155)and 52 cases of pregnant women with subhypothyroidism in the domestic standard group,the incidence rate was 2.41%(52/2155).The incidence of subhypothyroidism in the two groups was statistically significant(P<0.01);There were 73 cases of pregnant women with subhypothyroidism in the new foreign standard group were3.39%(73/2155)and in the domestic standard group,with an incidence of 2.41%(52/2155).There was no significant difference in the incidence of hypothyroidism between the two groups(P>0.05).(2)The incidence of pregnant women in the domestic standard group,the old foreign standard group and the foreign new standard group was compared with the normal control group,and the difference of the old standard group abroad was not statistically significant(P>0.05),the difference between the domestic standard group and the foreign new standard group was statistically significant(P<0.01).Conclusion(1)The prevalence of subhypothyroidism in the early pregnancy was higher and the adverse pregnancy outcome could be increased;(2)According to the standard of our country in 2012,using the local reference interval as the diagnostic standard(serum TSH level>5.360 mIU/L)is more suitable for local regional characteristics,and also conforms to the new international diagnostic standard in 2017.Avoid excessive treatment and reduce the occurrence of bad pregnancy outcome.According to the old international diagnostic standard(serum TSH level>2.5 mIU/L in the early pregnancy,>3.0 mIU/L in the middle and late stages),the diagnosis of subsubtract is too board for pregnancy management,increases the economic burden and psychological pressure of the patients,and is not conducive to the management of pregnancy.
引文
[1]ATA.Guideline of ATA for the diagnosis anti managenlent of thyroid disease during pregnancy and poststpartum[J].Thyroid,2012,21(10):1081.
[2]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南[J].中华围产学杂志,2012,15(7):385.
[3]ATA.Guideline of ATA for the diagnosis anti managenlent of thyroid disease during pregnancy and poststpartum[S].Thyroid,2017,Jan 6.doi:10.1089/thy.2016.0457.
[4]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737.
[5]Glinoer D.The regulation of thyroid function in pregnancy:pathways of endocrine adaptation from physiology to pathology[J].Endocr Rev,1997,18(3):404.
[6]Zubair B,Pierre C,Bemard CD,et al.Laboratory medicine practice guidelines[J].Thyroid,2003,13(2):123.
[7]Tudela CM,Casey BM,McIntire DD,et al.Relationship of subclinical thyroid disease to the incidence of gestational diabetes[J].Obstet Gynecol,2012,119(5):983.
[8]Andersen SL,Laurberg P.Iodine Supplementation in pregnancy and the dilemma of ambiguous recommendations[J].Eur Thyroid J,2016,5(1):35.
[9]翟华丽,沈建军,杨瑞利,等.妊娠期亚临床甲状腺功能减退症与妊娠结局的相关性[J].海南医学,2016,27(7):1065.
[10]Motavalli LR,Hakimabad HM,Azghadi EH.Fetal and maternal dose assessment for diagnostic scans during pregnancy[J].Phys Med Biol,2016,61(9):3596.
[11]Lazarus JH.Screening for thyroid dysfunction in pregnancy:Is it worth while[J].J Thyroid Res,2011,2011(6):397012.
[12]Sahu MT,Das V,Mittal S,et al.Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome[J].Arch Gynecol Obstet,2010,281(2):215.
[13]Wang S,Teng WP,Li JX,et al.Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy[J].J Endocrinol Invest,2012,35(3):322.
[14]Ashoor G,Maiz N,Rotas M,et al.Maternal thyroid function at11to 13weeks of gestation and subsequent fetal death[J].Thyroid,2010,20(9):989.
[15]Wang S,Teng W,Gao Y,et al.Early levothyroxine treatment on maternal subclinical hypothyroidism improves spatial learning of offspring in rats[J].J Neuroendocrinol,2012,24(5):841.
[16]Karakosta P,Alegakis D,Georgiou VA,et al.Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes[J].Journal of Clinical Endocrinology&Metabolism,2012,97(12):4464.
[2]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南[J].中华围产学杂志,2012,15(7):385.
[3]ATA.Guideline of ATA for the diagnosis anti managenlent of thyroid disease during pregnancy and poststpartum[S].Thyroid,2017,Jan 6.doi:10.1089/thy.2016.0457.
[4]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737.
[5]Glinoer D.The regulation of thyroid function in pregnancy:pathways of endocrine adaptation from physiology to pathology[J].Endocr Rev,1997,18(3):404.
[6]Zubair B,Pierre C,Bemard CD,et al.Laboratory medicine practice guidelines[J].Thyroid,2003,13(2):123.
[7]Tudela CM,Casey BM,McIntire DD,et al.Relationship of subclinical thyroid disease to the incidence of gestational diabetes[J].Obstet Gynecol,2012,119(5):983.
[8]Andersen SL,Laurberg P.Iodine Supplementation in pregnancy and the dilemma of ambiguous recommendations[J].Eur Thyroid J,2016,5(1):35.
[9]翟华丽,沈建军,杨瑞利,等.妊娠期亚临床甲状腺功能减退症与妊娠结局的相关性[J].海南医学,2016,27(7):1065.
[10]Motavalli LR,Hakimabad HM,Azghadi EH.Fetal and maternal dose assessment for diagnostic scans during pregnancy[J].Phys Med Biol,2016,61(9):3596.
[11]Lazarus JH.Screening for thyroid dysfunction in pregnancy:Is it worth while[J].J Thyroid Res,2011,2011(6):397012.
[12]Sahu MT,Das V,Mittal S,et al.Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome[J].Arch Gynecol Obstet,2010,281(2):215.
[13]Wang S,Teng WP,Li JX,et al.Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy[J].J Endocrinol Invest,2012,35(3):322.
[14]Ashoor G,Maiz N,Rotas M,et al.Maternal thyroid function at11to 13weeks of gestation and subsequent fetal death[J].Thyroid,2010,20(9):989.
[15]Wang S,Teng W,Gao Y,et al.Early levothyroxine treatment on maternal subclinical hypothyroidism improves spatial learning of offspring in rats[J].J Neuroendocrinol,2012,24(5):841.
[16]Karakosta P,Alegakis D,Georgiou VA,et al.Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes[J].Journal of Clinical Endocrinology&Metabolism,2012,97(12):4464.