[1]薛 娟,张媛媛,刘 娜.不明原因复发性流产患者再次妊娠孕早期甲状腺功能与宫内妊娠结局关系研究[J].陕西医学杂志,2022,51(5):566-569.[doi:DOI:10.3969/j.issn.1000-7377.2022.05.012]
　XUE Juan,ZHANG Yuanyuan,LIU Na.Relationship between thyroid function in early stage of second pregnancy and intrauterine pregnancy outcome in patients with unexplained recurrent abortion[J].,2022,51(5):566-569.[doi:DOI:10.3969/j.issn.1000-7377.2022.05.012]
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不明原因复发性流产患者再次妊娠孕早期甲状腺功能与宫内妊娠结局关系研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年5期
页码:
566-569
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

Title:
Relationship between thyroid function in early stage of second pregnancy and intrauterine pregnancy outcome in patients with unexplained recurrent abortion
作者:
薛 娟; 张媛媛; 刘 娜
(延安大学附属医院生殖医学中心,陕西 延安 716000)
Author(s):
XUE Juan; ZHANG Yuanyuan; LIU Na
(Reproductive Medicine Center,Affiliated Hospital of Yan'an University,Yan'an 716000,China)
关键词:
复发性流产;  再次妊娠;  孕早期;  甲状腺功能;  宫内妊娠结局;  预测效能
Keywords:
Recurrent abortion;  Second pregnancy;  Early pregnancy;  Thyroid function;  Intrauterine pregnancy outcome;  Predictive efficiency
分类号:
R 715.9
DOI:
DOI:10.3969/j.issn.1000-7377.2022.05.012
文献标志码:
A
摘要:
目的:探讨不明原因复发性流产患者再次妊娠孕早期甲状腺功能与宫内妊娠结局的关系。方法:选择接受规律产检的85例不明原因复发性流产患者作为观察组,另选同期产检的85例正常早期孕妇作为对照组。所有孕妇均于孕9～12周检测甲状腺功能指标,包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TgAb),分析孕早期甲状腺功能指标对宫内妊娠结局不良的预测效能。结果:观察组血清FT3、FT4水平均低于对照组,TSH、TPOAb、TgAb水平均高于对照组,两组比较差异均有统计学意义(均P<0.05); 观察组宫内妊娠结局良好53例、不良32例; 宫内妊娠结局不良组血清FT3、FT4水平均低于宫内妊娠结局良好组,TSH、TPOAb、TgAb水平均高于宫内妊娠结局良好组,两组比较差异均有统计学意义(均P<0.05); 经多因素Logistic回归分析,FT3和TSH均是不明原因复发性流产患者再次妊娠宫内妊娠结局不良的独立预测因素(P<0.05); 经受试者工作特征曲线(ROC)分析,血清FT3联合TSH预测不明原因复发性流产患者再次妊娠宫内妊娠结局不良的AUC为0.923,敏感度为87.69%,特异度为88.15%。结论:不明原因复发性流产患者再次妊娠孕早期甲状腺功能减退可能是引起妊娠期自发性流产的重要原因,血清FT3联合TSH预测宫内妊娠结局不良的效能较好,值得临床予以重视。
Abstract:
Objective:To investigate the relationship between the thyroid function in the early stage of second pregnancy and the outcome of intrauterine pregnancy in patients with unexplained recurrent abortion.Methods: Eighty-five patients with unexplained recurrent abortion who received regular obstetric examination were selected as the observation group,and eighty-five normal early pregnant women who received obstetric examination during the same period were selected as the control group.Thyroid function indexes including free triiodothyrosine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),anti-thyroid peroxidase antibody(TPOAb),anti-thyroglobulin antibody(TgAb)were detected in all pregnant women at 9 to 12 weeks of gestation.The predictive efficacy of thyroid function index in early pregnancy for adverse intrauterine pregnancy outcome was analyzed.Results:The levels of serum FT3 and FT4 in the observation group were lower than those in the control group,and the levels of TSH,TPOAb and TgAb were higher than those in the control group(all P<0.05).Among 85 cases of recurrent abortion with unknown cause,53 cases had good outcome and 32 cases had bad outcome.The levels of serum FT3 and FT4 in the group with poor intrauterine pregnancy outcome were lower than those in the group with good intrauterine pregnancy outcome,and the levels of TSH,TPOAb and TgAb in the group with poor intrauterine pregnancy outcome were higher than those in the group with good intrauterine pregnancy outcome(all P<0.05).Logistic regression analysis showed that FT3 and TSH were independent predictors of poor intrauterine pregnancy outcome in patients with unexplained recurrent abortion(all P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the AUC of serum FT3 combined with TSH in predicting poor outcome of intrauterine pregnancy in patients with unexplained recurrent miscarriage was 0.923,with a sensitivity of 87.69% and a specificity of 88.15%.Conclusion:Hypothyroidism in the early stage of second pregnancy in patients with unexplained recurrent abortion may be an important cause of spontaneous abortion during pregnancy,serum FT3 combined with TSH has a good efficacy in predicting the adverse outcome of intrauterine pregnancy.

参考文献/References:

[1] 金素芳,方锦川,李 石,等.重组人粒细胞集落刺激因子宫腔灌注对复发性流产患者子宫内膜容受性及妊娠结局的影响[J].陕西医学杂志,2020,49(5):592-594,封3.
[2] Li X,Xu P.Effect of serum Th1/Th2 cytokine imbalance on the occurrence and development of various chronic glomerulonephritis[J].Acta Medica Mediterranea,2018,34(4):1059-1063.
[3] 李佳钋,侯 悦,李 凡,等.复发性流产患者妊娠早期边缘性亚临床甲状腺功能减退症的研究[J].中华内分泌代谢杂志,2021,37(6):516-521.
[4] 柴丽娅,刘立立,佟 玉,等.左旋甲状腺素片治疗孕早期合并亚临床甲状腺功能减退对妊娠结局的影响[J].中国妇幼保健,2018,33(21):4866-4869.
[5] 李国华,李阳阳,鲍时华.不明原因复发性流产患者孕前维生素D水平与妊娠结局的关系[J].中国医师杂志,2021,23(5):702-706.
[6] 郝莉娜.淋巴细胞主动免疫治疗复发性流产前后血清免疫组学比较[J].陕西医学杂志,2018,47(10):1294-1296.
[7] Korzeniowska KA,Brzeziński M,Szarejko K,et al.The association of thyroid-stimulating hormone(TSH)and free thyroxine(FT4)concentration levels with carbohydrate and lipid metabolism in obese and overweight teenagers[J].Endokrynologia Polska,2019,70(2):172-178.
[8] Huang K,Xu Y,Yan S,et al.Isolated effect of maternal thyroid-stimulating hormone,free thyroxine and antithyroid peroxidase antibodies in early pregnancy on gestational diabetes mellitus:A birth cohort study in China[J].Endocrine Journal,2019,66(3):223-231.
[9] 房秋霞,舒 展,杨金铭,等.妊娠期亚临床甲状腺功能减退症对妊娠结局和胎儿不良影响研究[J].陕西医学杂志,2018,47(3):338-340,343.
[10] Bekman NI,Laricheva SY,Bychenkova TA,et al.Simultaneous detection of thyroid-stimulating hormone and free thyroxin in dried spots of human blood by using phosphorescent nanoparticles[J].Russian Journal of Bioorganic Chemistry,2020,46(2):199-206.
[11] 陈晶晶,何耀娟,陈爱兰,等.中西医结合孕前孕后并治不明原因早期复发性流产疗效研究[J].陕西中医,2018,39(7):827-829.
[12] 吴震溟,赵卫秀,汤春珠.甲状腺过氧化物酶抗体表达对孕期甲状腺功能紊乱疾病及妊娠结局的影响[J].中国妇幼保健,2019,34(6):1246-1249.
[13] Taszkun I,Milczak A,Kalisz G,et al.Serum tT4,FT4 and TSH concentrations in German Shepherd dogs depending on age and type of work[J].Polish Journal of Veterinary Sciences,2021,24(1):63-68.
[14] Yang J,Yi N,Zhang J,et al.Generation and characterization of a hypothyroidism rat model with truncated thyroid stimulating hormone receptor[J].Scientific Reports,2018,8(1):4004.
[15] 陈爱兰,曾小变,罗婕妤.先兆流产早期血清Hcy、TPOAb、TGAb水平的变化及其预后分析[J].海南医学,2021,32(7):864-867.
[16] Neves JS,Castro OS,Souteiro P,et al.Effect of weight loss after bariatric surgery on thyroid-stimulating hormone levels in patients with morbid obesity and normal thyroid function[J].Obesity Surgery,2018,28(1):97-103.
[17] Oba J,Esmaeli B,Ellerhorst JA,et al.Trends in hepatocyte growth factor,insulin-like growth factor 1,thyroid-stimulating hormone,and leptin expression levels in uveal melanoma patient serum and tumor tissues[J].Melanoma Research,2017,27(2):126-133.
[18] 李 嫔.孕期甲状腺疾病对胎儿发育及新生儿健康的影响[J].中华实用儿科临床杂志,2019,34(8):574-577.
[19] 苏普玉,郝加虎,黄 锟,等.孕20周内母体甲状腺功能与婴幼儿体格及神经精神发育剂量反应关系的前瞻性队列研究[J].中华流行病学杂志,2019,40(2):180-185.
[20] Feng X,Huang J,Peng Y,et al.Association between decreased thyroid stimulating hormone and hyperuricemia in type 2 diabetic patients with early-stage diabetic kidney disease[J].BMC Endocr Disord,2021,21(1):1-10.

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备注/Memo

备注/Memo:
基金项目:陕西省教育厅专项科研计划项目(21JK0974)
更新日期/Last Update: 2022-05-05