妊娠期合并亚临床甲减患者的TSH、FT3、FT4水平与血压变异性及妊娠结局相关性分析
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摘要
目的:观察妊娠期合并亚临床甲减患者的促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平及血压变异性,分析其相关性。方法:选取2015年1月—2018年1月两家医院接受治疗的妊娠期合并亚临床甲减患者为观察组,选取同期两家医院孕检无亚临床甲减的妊娠期孕妇为对照组。观察两组孕妇TSH、FT3、FT4、血压和血压变异性差异及其相关性。结果:观察组FT3水平低于对照组、TSH水平高于对照组(P<0.05),而FT4水平两组无差别(P>0.05); SBP、DBP、24hSBP SD、24hDBP SD、24hSBP ARV和24hDBP ARV水平均高于对照组,胎头下降停滞发生率高于对照组(P<0.05),而两组产后出血、流产和早产发生率无差别(P>0.05);观察者FT3水平与血压及其变异性负相关,TSH与血压及其变异性正相关, FT4水平与血压及其变异性无明显相关关系。结论:妊娠期合并亚临床甲减患者的TSH水平较高,FT3水平较低,且与血压及变异性密切相关。
Objective: To observe the levels of TSH, TT3, TT4, and blood pressure variability of pregnant women with subclinical hypothyroidism, and to analyze the correlation between the TSH, FT3 and FT4 levels and blood pressure variability. Methods: The pregnant women with subclinical hypothyroidism were selected in study group from January 2015 to January 2018, and normal pregnant women were selected in control group. The levels of TSH, FT3 and FT4, and blood pressure and blood pressure variability of women were observed, and their correlation was analyzed. Results: The level of FT3 of women in study group was significant lower than that of women in control group, and the level of TSH was significant higher than that of women in control group(P<0.05), but there was no significant different in the level of FT4 between the two groups(P>0.05). The values of SBP, DBP, 24 hSBP SD, 24 hDBPSD, 24 hSBPARV and 24 hDBP ARV, and the incidence of fetal head stagnation of women in study group was significant higher than those of women in control group(P<0.05), but there was no significant difference in the incidence of postpartum hemorrhage, miscarriage and premature delivery between the two groups(P>0.05).In study group, the FT3 level of women was negatively related to blood pressure and its variability, and TSH level of women was positively related to blood pressure and its variability, whereas FT4 level of women was no associated with blood pressure and its variability. Conclusion: The level of TSH of pregnant women with subclinical hypothyroidism is high, and the level of FT3 is low, which is closely related to blood pressure and its variability.
Objective: To observe the levels of TSH, TT3, TT4, and blood pressure variability of pregnant women with subclinical hypothyroidism, and to analyze the correlation between the TSH, FT3 and FT4 levels and blood pressure variability. Methods: The pregnant women with subclinical hypothyroidism were selected in study group from January 2015 to January 2018, and normal pregnant women were selected in control group. The levels of TSH, FT3 and FT4, and blood pressure and blood pressure variability of women were observed, and their correlation was analyzed. Results: The level of FT3 of women in study group was significant lower than that of women in control group, and the level of TSH was significant higher than that of women in control group(P<0.05), but there was no significant different in the level of FT4 between the two groups(P>0.05). The values of SBP, DBP, 24 hSBP SD, 24 hDBPSD, 24 hSBPARV and 24 hDBP ARV, and the incidence of fetal head stagnation of women in study group was significant higher than those of women in control group(P<0.05), but there was no significant difference in the incidence of postpartum hemorrhage, miscarriage and premature delivery between the two groups(P>0.05).In study group, the FT3 level of women was negatively related to blood pressure and its variability, and TSH level of women was positively related to blood pressure and its variability, whereas FT4 level of women was no associated with blood pressure and its variability. Conclusion: The level of TSH of pregnant women with subclinical hypothyroidism is high, and the level of FT3 is low, which is closely related to blood pressure and its variability.
引文
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[2] Korevaar T I M. Normalization of TSH in Women with Mild Subclinical Hypothyroidism During Pregnancy Bears a Low Risk of Overtreatment[J]. 2016, 28(6):174-177.
[3] 程小侠, 史征, 王玉珠,等. 妊娠期甲状腺功能减退与妊娠不良结局的相关性分析[J]. 中国临床医生杂志, 2015,44(8):68-70.
[4] 霍志平, 李红霞, 杜巍,等. 甲状腺功能减退与妊娠期糖尿病对孕妇妊娠结局及新生儿不良结局的影响[J]. 临床与病理杂志, 2015, 35(12):2112-2116.
[5] 王婷婷, 陆汉魁. 促甲状腺激素检测研究现状及进展[J]. 医学综述, 2016, 22(24):4895-4898.
[6] 马雅辉, 王立, 闫晓颖. 妊娠期血清中FT_3、FT_4、TT_3、TT_4和TSH的变化范围对孕妇甲状腺功能诊断的参考[J]. 标记免疫分析与临床, 2016, 23(5):480-483.
[7] Kalampoki L, Tsanadis G, Stefos T. Subclinical Hypothyroidism and Isolated Hypothyroxinemia during Pregnancy and Their Association with Pregnancy Outcome: A 2-Year Study[J]. Open Journal of Obstetrics & Gynecology, 2017, 07(7):693-701.
[8] Pavanaganga A, Rekha B R, Sailakshmi M P A, et al. Observational Study of Subclinical Hypothyroidism in Pregnancy[J]. 2015, 2(4):255.
[9] 黄勇. 硒酵母辅助左旋甲状腺素对慢性淋巴细胞性甲状腺炎伴甲减免疫调节的机制研究[J]. 河北医药, 2016, 38(10):1524-1526.
[10] 郭敏, 董晓秋, 王思明,等. 不同甲状腺功能状态下慢性淋巴细胞性甲状腺炎声像图及弹性成像特征[J]. 中华地方病学杂志, 2015, 34(5):379-383.
[11] 赵蔚, 朱加娟. 甲状腺素治疗对妊娠合并甲减患者妊娠结局及子代的影响[J]. 浙江医学, 2015, 37(23):1931-1933.
[12] 任秀莲. 妊娠期亚临床甲减的临床研究[D]. 昆明医科大学, 2012.
[13] 张菲, 彭伟, 林彦琳,等. 妊娠前半期妇女血清 TSH 水平与妊娠结局的相关性研究[J]. 中华内分泌代谢杂志, 2017, 33(1):52-55.
[14] 王静. 妊娠期高血压疾病与甲状腺功能减低的关系研究[D]. 天津医科大学, 2013.
[15] 宋娜. 甲状腺功能减退与妊娠期高血压疾病关系探讨[D]. 吉林大学, 2014.