Graves’甲亢对妊娠结局的影响
摘要
目的:探讨Graves’甲亢对妊娠结局的影响。方法:选取Graves’甲亢孕妇95例,其中37例入组时甲状腺功能控制良好(控制组),58例入组时甲状腺功能控制不佳(未控制组);根据入组时是否使用抗甲状腺药物(ATDs)再分成用ATDs与未用ATDs亚组。选取同期正常妊娠产妇125例作为正常对照组。分析各组孕期甲状腺功能和促甲状腺激素受体抗体(TRAb)水平变化及其对妊娠结局的影响。结果:控制组中孕期甲功持续缓解占24.32%(9/37),缓解及甲功完全正常的比例为37.84%(14/37)和16.22%(6/37),有8.11%的孕妇甲亢复发。未控制组62.07%的孕妇孕期持续甲亢,甲功缓解及完全正常分别有18.97%(11/58)和15.51%(9/58)。未控制组TRAb水平在孕早、中、晚期及产后均显著高于控制组(P<0.05);两组孕早期TRAb均显著高于孕中期(P<0.05)。未控制组妊娠高血压、子痫前期、低出生体重、产后出血及新生儿甲减的发生率显著高于控制组及对照组(P<0.05),控制组与对照组比较差异无统计学意义(P>0.05)。结论:Graves’甲亢对妊娠结局产生不良影响。孕期甲亢控制不佳增加母婴不良结局的发生。合理使用抗甲状腺药物可稳定甲功和TRAb,但由于其可通过胎盘,可能导致胎儿或新生儿甲减的发生,仍需谨慎使用。
引文
[1]Hawken C,Sarreau M,Bernardin M,et al.Management of Graves’disease during pregnancy in the Poitou-Charentes Region[J].Ann Endocrinol(Paris),2016,77(5):570-577
[2]Patil-Sisodia K,Mestman JH.Graves’hyperthyroidismand pregnancy:a clinical update[J].Endocr Pract,2010,16(1):118-129
[3]熊业春.Graves’病孕产妇不同孕期TRAb水平的变化及临床意义[J].临床医学研究与实践,2016,1(8):22-23
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[5]Gietka-Czernel M,Debska M,Kretowicz P,et al.Hyper-thyroidism during pregnancy--the role of measuring mater-nal TSH receptor antibodies and foetal ultrasound monitor-ing[J].Endokrynol Pol,2014,65(4):259-268
[6]Mestman JH.Hyperthyroidism in pregnancy[J].BestPract Res Clin Endocrinol Metab,2004,18(2):267-288
[7]Tagami T,Hagiwara H,Kimura T,et al.The incidence ofgestational hyperthyroidism and postpartum thyroiditis intreated patients with Graves’disease[J].Thyroid,2007,17(8):767-772
[8]Amino N,Izumi Y,Hidaka Y,et al.No increase of block-ing type anti-thyrotropin receptor antibodies during preg-nancy in patients with Graves’disease[J].J Clin Endocri-nol Metab,2003,88(12):5871-5874
[9]Chan GW,Mandel SJ.Therapy insight:management ofGraves’disease during pregnancy[J].Nat Clin Pract En-docrinol Metab,2007,3(6):470-478
[10]Panesar NS,Li CY.Reference intervals for thyroid hor-mones in pregnant Chinese women[J].Ann Clin Bio-chem,2001,38(4):329-332
[11]Alexander EK,Pearce EN,Brent GA,et al.2017 Guide-lines of the American Thyroid Association for the diagno-sis and management of thyroid disease during pregnancyand the postpartum[J].Thyroid,2017,27(3):315-389
[12]Wang Y,Sun XL,Wang CL,et al.Influence of screeningand intervention of hyperthyroidism on pregnancy outcome[J].Eur Rev Med Pharmacol Sci,2017,21(8):1932-1937
[13]Millar LK,Wing DA,Leung AS,et al.Low birth weightand preeclampsia in pregnancies complicated by hyper-thyroidism[J].Obstet Gynecol,1994,84(6):946-949
[14]Uenaka M,Tanimura K,Tairaku S,et al.Risk factors forneonatal thyroid dysfunction in pregnancies complicatedby Graves’disease[J].Eur J Obstet Gynecol Reprod Bi-ol,2014,177(1):89-93
[15]周进福,罗金英,赵红,等.125例新生儿先天性甲状腺功能减低症围产因素分析[J].中华流行病学杂志,2015,36(7):747-751
[16]Matsuura N,Konishi J,Fujieda K,et al.TSH-receptor an-tibodies in mothers with Graves’disease and outcome intheir offspring[J].Lancet,1988,1(6):14-17
[17]中华医学会儿科学分会内分泌遗传代谢学组.先天性甲状腺功能减低症诊疗共识[J].中华儿科杂志,2011,49(6):421-424
[2]Patil-Sisodia K,Mestman JH.Graves’hyperthyroidismand pregnancy:a clinical update[J].Endocr Pract,2010,16(1):118-129
[3]熊业春.Graves’病孕产妇不同孕期TRAb水平的变化及临床意义[J].临床医学研究与实践,2016,1(8):22-23
[4]Matthews DC,Syed AA.The role of TSH receptor antibod-ies in the management of Graves’disease[J].Eur J In-tern Med,2011,22(3):213-216
[5]Gietka-Czernel M,Debska M,Kretowicz P,et al.Hyper-thyroidism during pregnancy--the role of measuring mater-nal TSH receptor antibodies and foetal ultrasound monitor-ing[J].Endokrynol Pol,2014,65(4):259-268
[6]Mestman JH.Hyperthyroidism in pregnancy[J].BestPract Res Clin Endocrinol Metab,2004,18(2):267-288
[7]Tagami T,Hagiwara H,Kimura T,et al.The incidence ofgestational hyperthyroidism and postpartum thyroiditis intreated patients with Graves’disease[J].Thyroid,2007,17(8):767-772
[8]Amino N,Izumi Y,Hidaka Y,et al.No increase of block-ing type anti-thyrotropin receptor antibodies during preg-nancy in patients with Graves’disease[J].J Clin Endocri-nol Metab,2003,88(12):5871-5874
[9]Chan GW,Mandel SJ.Therapy insight:management ofGraves’disease during pregnancy[J].Nat Clin Pract En-docrinol Metab,2007,3(6):470-478
[10]Panesar NS,Li CY.Reference intervals for thyroid hor-mones in pregnant Chinese women[J].Ann Clin Bio-chem,2001,38(4):329-332
[11]Alexander EK,Pearce EN,Brent GA,et al.2017 Guide-lines of the American Thyroid Association for the diagno-sis and management of thyroid disease during pregnancyand the postpartum[J].Thyroid,2017,27(3):315-389
[12]Wang Y,Sun XL,Wang CL,et al.Influence of screeningand intervention of hyperthyroidism on pregnancy outcome[J].Eur Rev Med Pharmacol Sci,2017,21(8):1932-1937
[13]Millar LK,Wing DA,Leung AS,et al.Low birth weightand preeclampsia in pregnancies complicated by hyper-thyroidism[J].Obstet Gynecol,1994,84(6):946-949
[14]Uenaka M,Tanimura K,Tairaku S,et al.Risk factors forneonatal thyroid dysfunction in pregnancies complicatedby Graves’disease[J].Eur J Obstet Gynecol Reprod Bi-ol,2014,177(1):89-93
[15]周进福,罗金英,赵红,等.125例新生儿先天性甲状腺功能减低症围产因素分析[J].中华流行病学杂志,2015,36(7):747-751
[16]Matsuura N,Konishi J,Fujieda K,et al.TSH-receptor an-tibodies in mothers with Graves’disease and outcome intheir offspring[J].Lancet,1988,1(6):14-17
[17]中华医学会儿科学分会内分泌遗传代谢学组.先天性甲状腺功能减低症诊疗共识[J].中华儿科杂志,2011,49(6):421-424