妊娠合并甲状腺功能异常患者子代甲状腺功能评估

Evaluation of thyroid function of offspring in pregnant women with thyroid dysfunction

摘要

目的 分析妊娠合并甲状腺功能异常孕妇其子代甲功及甲功五项变化,为临床应用提供依据。方法 选择2020年1月至2022年6月在我院收治的100例甲状腺功能异常孕妇作为研究对象,根据诊断结果进一步分为甲减组(n=50)和甲亢组(n=50),同期选择50例正常妊娠的健康孕妇作为对照组;所有孕妇在妊娠12周及妊娠24周孕检时采集空腹静脉血,检测受试者血中血清游离三碘甲状腺原氨酸(FT₃)、血清游离甲状腺素(FT₄)、促甲状腺激素(TSH)、三碘甲状原氨酸(T₃)、甲状腺素(T₄)水平;分娩后6周及12周时采集幼儿空腹静脉血,检测FT₃、FT₄、TSH、T₃、T₄水平;采用Spearman相关性分析母亲甲状腺功能状况与其子代甲功变化及甲功五项的相关性。结果 甲亢组、甲减组和对照组的孕妇在妊娠24周时FT₃、FT₄、TSH、T₃、T₄水平与妊娠12周相比存在显著差异(P<0.05);甲亢组在妊娠24周时FT₃、FT₄、T₃、T₄水平最高,TSH水平最低,甲减组在妊娠24周时FT₃、FT₄、T₃、T₄水平最低,TSH水平最高;甲减组孕妇其子代在出生后6周和12周时出现甲状腺功能减退的人数占比分别为34.0%、38.0%;甲亢组、甲减组的子代在产后12周FT₃、FT₄、TSH、T₃、T₄水平与产后12周时对照组的子代相比存在显著差异(P<0.05),甲亢组的子代在产后12周时FT₃、FT₄、T₃、T₄水平最高,TSH水平最低,甲减组的子代在产后12周时FT₃、FT₄、T₃、T₄水平最低,TSH水平最高;孕妇甲状腺功能状况与子代甲状腺功能状况呈显著正相关关系(r=0.703,P<0.05);孕妇甲状腺功能状况与其子代的FT₃、FT₄、T₃、T₄水平呈显著正相关关系(r值分别为0.765、0.694、0.685、0.727),与TSH水平呈显著负相关关系(r=-0.703),且差异均存在统计学意义(P<0.05)。结论 孕妇甲状腺功能状态与其子代甲功变化及甲功五项存在显著性相关关系,尤其是妊娠期甲减孕妇,应对其进行及时干预治疗并密切关注子代甲状腺功能状况,防止对婴儿发育和智力产生不良影响.

Abstract

Objective To observe and analyze changes in thyroid function status and five items of thyroid function of offspring of pregnant women with thyroid dysfunction, so as to provide a basis for clinical practice. Methods 100 pregnant women with abnormal thyroid function who admitted to our hospital from January 2020 to June 2022 were selected as research subjects, and all pregnant women were divided into hypothyroidism group and hyperthyroidism group according to thyroid function of the pregnant woman (n=50 in each group). Other 50 healthy pregnant women with normal thyroid function were as the control group. Fasting venous blood was collected for all pregnant women at 12 weeks and 24 weeks of gestation (G12 and G24), and serum levels of free triiodothyronine (FT₃), free tetraidothyronine (FT₄), thyroid-stimulating hormone (TSH), triiodothyronine (T₃) and tetraidothyronine (T₄) of them were detected. At 6 months and 12 months after birth, the fasting venous blood of the infants was collected, and the serum levels of FT ₃, FT₄, TSH, T₃ and T₄ were detected also. Spearman correlation was used to analyze correlations of maternal thyroid function statuses with changes in thyroid function status and five items of thyroid function of the offspring. Results At G24, the serum levels of FT₃, FT₄, TSH, T₃ and T₄ of the pregnant women in the hyperthyroidism group, the hypothyroidism group and the control group were all significantly different from those at G12, and the differences were statistically significant (all P<0.05). In the hyperthyroid group, the serum FT₃, FT₄, TSH, T₃ and T₄ levels of the pregnant women were the highest and the TSH level was the lowest at G24, while in the hypothyroidism group, the serum FT₃, FT₄, T₃ and T₄ levels were the lowest and the TSH level was the highest at G24. And in the hypothyroidism group, the proportions of hypothyroidism in the offspring at 6 weeks and 12 months after birth were 34% and 38% respectively. At 12 weeks after birth, the serum levels of FT₃, FT₄, T₃ and T₄ of the infants in the hyperthyroidism group and the hypothyroidism group were different from those of the infants in the control group (all P<0.05). The serum levels of FT₃, FT₄, TSH, T₃ and T₄ of the offspring in the hyperthyroidism group and the hypothyroidism group were significantly different from those of the offspring in the control group at 12 weeks after birth (all P<0.05): the serum levels of FT₃, FT₄, T₃ and T₄ of the offspring in the hyperthyroidism group were the highest and the TSH level was the lowest at 12 weeks after birth, while in the hypothyroidism group, the serum levels of FT₃, FT₄, T₃ and T₄ of the offspring were the lowest and the TSH level was the highest at 12 weeks after birth. The maternal thyroid function status was significantly positively correlated with her offspring's thyroid function status (r=0.703, P<0.05), and the thyroid function statuses of the pregnant women were significantly positively correlated with serum levels of FT₃, FT₄, T₃ and T₄ of their offspring (r=0.765, 0.694, 0.685 and 0.727 respectively), while the maternal serum TSH level was negatively correlated with that of their offspring (r=-0.703), and the differences were all statistically significant (all P<0.05). Conclusion There are significant correlations between the maternal thyroid function statuses and their offspring's changes in thyroid function and the five items of thyroid function. Especially for those pregnant women with hypothyroidism, timely interventions and treatment should be given, and the thyroid function statuses of their offspring should be focused closely, in order to prevent from adverse effects of maternal hypothyroidism on physical development and intellectual development of their offspring.

关键词

甲亢 / 甲减 / 妊娠 / 婴儿 / 甲状腺功能 / 甲功五项

Key words

hyperthyroidism / hypothyroidism / pregnancy / infant / thyroid function / five items of thyroid function

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