标题：先兆流产早期血清Hcy、TPOAb、TGAb水平的变化及其预后分析

      作者：陈爱兰，曾小变，罗婕妤    湛江市第二人民医院妇产科，广东 湛江 524000

      卷次： 2021年32卷7期

      【摘要】 目的 分析先兆流产早期孕妇血清同型半胱氨酸(Hcy)、甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)水平的变化及其对预后的影响。方法 选取湛江市第二人民医院妇产科于2019年1月至2020年10月收治的79例因早期先兆流产行保胎治疗的孕妇为研究对象(保胎组)，并根据其甲状腺功能分为甲功正常组43例和甲减组36例，另选取79例同期于本院产检的正常孕妇作为对照组。检测并比较先兆流产行保胎治疗的孕妇和对照组孕妇的血清Hcy、TPOAb、TGAb水平，采用Spearman秩相关分析法分析血清Hcy、TPOAb、TGAb水平与早期先兆流产的相关性；比较甲功正常组和甲减组孕妇的TPOAb、TGAb阳性检测率；先兆流产行保胎治疗的孕妇给予药物治疗，随访至妊娠结束，比较甲功正常组和甲减组孕妇的妊娠结局。结果 保胎组孕妇的血清Hcy、TPOAb、TGAb水平分别为(5.57±2.27) μmol/L、(214.71±12.81) IU/mL、(134.27±15.16) IU/mL，明显高于对照组的(4.52±2.51) μmol/L、(1.74±0.28) IU/mL、(0.98±0.10) IU/mL，差异均有统计学意义(P<0.05)；血清Hcy、TPOAb、TGAb水平与早期先兆流产呈正相关(r=0.495、0.532、0.501，P<0.01)；甲减组孕妇的 TPOAb、TGAb阳性检测率分别为30.56%、36.11%，明显高于甲功正常组的9.30%、13.95%，差异均有统计学意义(P<0.05)；治疗后，甲功正常组和甲减组保胎结局比较差异无统计学意义(P>0.05)。结论 血清Hcy、TPOAb、TGAb水平与早期先兆流产发生具有一定相关性，且甲状腺功能减退是主要原因之一，可通过药物治疗提高保胎率，改善妊娠结局。
      【关键词】 早期先兆流产；同型半胱氨酸；甲状腺过氧化物酶抗体；抗甲状腺球蛋白抗体；甲状腺功能；预后
      【中图分类号】 R714.21 【文献标识码】 A 【文章编号】 1003—6350（2021）07—0864—04

Changes of serum Hcy, TPOAb, and TGAb levels in early threatened abortion and their prognostic analysis.CHEN Ai-lin, ZENG Xiao-bian, LUO Jie-yu.
Department of Obstetrics and Gynecology, Zhanjiang Second People'sHospital, Zhanjiang 524000, Guangdong, CHINA
【Abstract】 Objective To analyze the changes of serum homocysteine (Hcy), thyroid peroxidase antibody(TPOAb), anti-thyroglobulin antibody (TGAb) levels in early threatened abortion and their influence on the prognosis.Methods A total of 79 pregnant women with early threatened abortion, who admitted to Department of Obstetrics andGynecology, Zhanjiang Second People's Hospital from January 2019 to September 2020, were selected as the observa-tion group. The patients were divided into the normal thyroid function sub group (n=43) and hypothyroidism sub group(n=36) according to their thyroid function, and another 79 normal pregnant women who were undergoing obstetrics inthe hospital during the same period were selected as the control group. The serum Hcy, TPOAb and TGAb levels of preg-nant women in the observation group and the control group were tested and compared. Spearman rank correlation analy-sis was used to analyze the correlation between serum Hcy, TPOAb, TGAb levels and early threatened abortion; the posi-tive detection rates of TPOAb and TGAb in the normal group and the hypothyroidism group were compared. The obser-vation group was given medication and followed up until the end of pregnancy, and the pregnancy outcome of the nor-mal and hypothyroid group was compared. Results The serum Hcy, TPOAb, and TGAb levels of pregnant women inthe observation group were (5.57±2.27) μmol/L, (214.71±12.81) IU/mL, (134.27±15.16) IU/mL, respectively, whichwere significantly higher than corresponding (4.52±2.51) mmol/L, (1.74±0.28) IU/mL, (0.98±0.10) IU/mL of the controlgroup (all P<0.05); the serum Hcy, TPOAb, TGAb levels were positively correlated with early threatened abortion (r=0.495, 0.532, 0.501, P<0.01); the positive detection rates of TPOAb and TGAb of pregnant women in the hypothyroid-ism sub group were 30.56% and 36.11%, respectively, which were significantly higher than 9.30% and 13.95% of thenormal thyroid function sub group (P<0.05). After treatment, there was no significant difference in the fetal preservationoutcome between the normal thyroid function group and the hypothyroidism group (P>0.05). Conclusion Serum levelsof Hcy, TPOAb, and TGAb have a certain correlation with the occurrence of early threatened abortion, and hypothyroidismis one of the main reasons. Drug treatment can be used to increase the pregnancy rate and improve pregnancy outcome.
      【Key words】 Early threatened abortion; Homocysteine (Hcy); Thyroid peroxidase antibody (TPOAb); Anti-thyro-globulin antibody (TGAb); Thyroid function; Prognosis