CTRP9、Ghrelin、TSH、TPO-Ab与亚临床甲状腺功能减退症患者妊娠结局的关系

The relationship between CTRP9, Ghrelin, TSH, TPO-Ab and pregnancy outcome of subclinical hypothyroidism patients

摘要

目的 分析妊娠期亚临床甲状腺功能减退症（SCH）患者C1q肿瘤坏死因子相关蛋白9（CTRP9）、胃饥饿素（Ghrelin）、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPO-Ab）水平及其与妊娠结局的关系。方法 将528例妊娠期SCH患者纳入研究作为病例组;纳入病例时间：2023年1月—2024年8月;医院：南阳市中心医院。另选取同期528名产前检查正常孕妇作为对照组。结果 入组2周后、分娩后较入组时,治疗组血清Ghrelin、TSH水平、TPO-Ab阳性占比均降低,且低于未治疗组,血清CTRP9水平则升高,且高于未治疗组（P<0.05）。相较未治疗组,治疗组不良妊娠结局总发生率更低（P<0.05）。相较对照组,病例组不良妊娠结局总发生率、血清Ghrelin、TSH水平、TPO-Ab阳性占比更高,血清CTRP9水平更低（P<0.05）。相较良好妊娠结局组,不良妊娠结局组血清CTRP9水平更低,血清Ghrelin、TSH水平、TPO-Ab阳性占比均更高（P<0.05）。绘制ROC曲线分析CTRP9、Ghrelin、TSH、TPO-Ab单独及联合检测对妊娠期SCH患者妊娠结局的预测价值,曲线下面积（AUC）分别为0.732、0.738、0.735、0.709、0.857,联合检测AUC最高（P<0.05）。结论 经过治疗,可稳定妊娠期SCH相关血清学指标水平,改善妊娠结局,此外,妊娠期SCH可增加产妇妊娠不良结局的概率,血清CTRP9、Ghrelin、TSH、TPO-Ab水平在妊娠期SCH患者中均呈现异常表达,且联合测定有助于提高妊娠期SCH患者的妊娠结局。

Abstract

Objective To analyze the levels of C1q tumor necrosis factor-related protein 9 (CTRP9), ghrelin, thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPO-Ab) in patients with subclinical hypothyroidism (SCH) during pregnancy and their relationship with pregnancy outcomes. Methods 528 pregnant women with SCH were included in the study as a case group. The time of inclusion was from January 2023 to August 2024. The hospital was Nanyang Central Hospital, and another 528 pregnant women with normal prenatal examination were selected as a control group. Results After 2 weeks in the group and after delivery, the serum Ghrelin, TSH and TPO-Ab levels in the treatment group were lower than those in the untreated group, while the serum CTRP9 level was higher than that in the untreated group (P<0.05). Compared with untreated group, the total incidence of adverse pregnancy outcome in treatment group was lower (P<0.05). Compared with the control group, the total incidence of adverse pregnancy outcome, serum Ghrelin, TSH levels, TPO-Ab positive ratio were higher and serum CTRP9 level was lower in the case group (P<0.05). Compared with the group with good pregnancy outcome, the level of serum CTRP9 in the group with bad pregnancy outcome was lower, while the levels of serum Ghrelin, TSH and the positive proportion of TPO-Ab were higher(P<0.05). Draw ROC curves to analyze the predictive value of CTRP9, Ghrelin, TSH, and TPO Ab detection alone and in combination for pregnancy outcomes in SCH patients during pregnancy. The area under the curve (AUC) is 0.732, 0.738, 0.735, 0.709, and 0.857, with the highest AUC for combined detection (P<0.05). Conclusion After treatment, it can stabilize the level of serum indicators related to SCH during pregnancy and improve the pregnancy outcome. In addition, SCH during pregnancy can increase the probability of adverse pregnancy outcome, and the serum levels of CTRP9, Ghrelin, TSH and TPO-Ab are all abnormally expressed in patients with SCH during pregnancy, and the combined determination is helpful to improve the pregnancy outcome of patients with SCH during pregnancy.

关键词

妊娠期亚临床甲状腺功能减退症 / C1q肿瘤坏死因子相关蛋白9 / 胃饥饿素 / 促甲状腺激素 / 甲状腺过氧化物酶抗体 / 妊娠结局

Key words

subclinical hypothyroidism during pregnancy / C1q tumor necrosis factor related protein 9 / ghrelin / thyroid stimulating hormone / thyroid peroxidase antibody / pregnancy outcome

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