标题：早孕期全面筛查甲状腺功能对改善妊娠结局的意义

      作者：陈雪兰，黄 平，李 辉
    (深圳市宝安区松岗人民医院妇产科，广东 深圳 518105)

      卷次： 2015年26卷18期

      【摘要】 目的 研究早孕期全面筛查甲状腺功能对改善妊娠结局的意义。方法 选择 2013年 1月 1日至
2014年6月30日在我院妇科门诊接受孕前筛查的4 202例早孕(孕周≤8周)孕妇作为研究对象。根据筛查结果
进行分组，其中以促甲状腺激素(TSH)及游离甲状腺素(FT4)等指标水平均有明显异常者为高风险组（236例），二
者均无明显异常者为低风险组(3 966例)。其中高风险组根据筛查的结果进一步分成A、B、C组。其中A组88例
有甲状腺病；B组48例有甲状腺相关病症；C组100例既往有其他甲状腺相关病史。对比不同风险程度的孕妇甲
状腺功能和抗体筛查情况，不同高风险孕妇群体中甲状腺功能异常者发病率，以及不同风险程度的孕妇最终妊
娠结局。结果 高风险组的甲状腺功能异常孕妇中甲减、甲亢以及总异常率均明显大于低风险组；高风险组的
甲状腺过氧化物酶抗体(TPOAb)阳性孕妇中甲状腺功能正常、异常率以及二者总比例均明显大于低风险组；高风
险组的甲状腺球蛋白抗体(TGAb)阳性孕妇的甲状腺功能异常率明显大于低风险组；B组中，既有TPOAb阳性，
又存在甲状腺功能正常者的比例明显高于A组；C组中，既有甲状腺功能异常，又存在甲亢的比例和总异常者的
比例显小于A组，既有TPOAb阳性，又存在甲状腺功能异常的比例和总异常者的比例明显小于A组；C组中，既
有TPOAb阳性，又存在甲状腺功能正常的比例和孕妇的总比例均明显小于B组；高风险组孕妇的早产、子痫前
期、产后出血、胎儿窘迫及胎盘早剥率均明显高于低风险组。上述各项指标比较差异均有统计学意义(P<0.05)。
结论 对早孕期孕妇实施甲状腺功能的全面筛查并给予相应治疗，可以较好地改善妊娠结局。

      【关键词】 妊娠；甲状腺功能；甲状腺自身抗体；筛查

      【中图分类号】 R714.12 【文献标识码】 A 【文章编号】 1003—6350（2015）18—2697—04


Significance of comprehensive screening of thyroid function in early pregnancy period for improvement of
pregnancy outcome.
CHEN Xue-lan, HUANG Ping, LI Hui. Department of Gynaecology and Obstetrics, Songgang
People's Hospital of Bao'an District of Shenzhen, Shenzhen 518105, Guangdong, CHINA

【Abstract】 Objective To study the significance of comprehensive screening of thyroid function in early
pregnancy period for improvement of pregnancy outcome. Methods From January 1, 2013 to June 30, 2014, a total
of 4 202 pregnant women in our hospital accepting prenatal examinations (with gestational age of less than 8 weeks)
were enrolled in the study. According to the results of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in-
dexes, the pregnant women were divided into high risk group (with significantly abnormal levels, 236 cases) and low
risk group (with normal levels, 3 966 cases). The high risk group was further divided into group A (88 cases, thyroid
disease), group B (48 cases, thyroid related disease), group C (100 cases, with history of other thyroid related diseases)
according to the screening results. The thyroid function, antibody screening of thyroid function in pregnant women
with different degree of risk, incidence of abnormal thyroid function, and final pregnancy outcome were compared.
Results The hyperthyroidism, hypothyroidism, and total abnormal ratio in pregnant women with abnormal thyroid
function in the high risk group were significantly higher than those in low risk group. Ratio of normal thyroid func-
tion, ratio of abnormal thyroid function, and overall ratio of two in TPOAb positive pregnant women at high risk
group were significantly higher than those in low risk group. The ratio of abnormal thyroid function in TGAb positive
pregnant women in the high risk group was significantly higher than that in the low risk group. In group B, the rate of
TPOAb positive pregnant women with normal thyroid function was higher than that in group A. In group C, the rate of
pregnant women with both abnormal thyroid function and hypothyroidism, as well as the total abnormal ratio were
lower than those in group A, and the rate of TPOAb positive pregnant women with abnormal thyroid function, as well
as the total abnormal ratio were smaller. In group C, the rate of TPOAb positive pregnant women with normal thyroid