摘要
目的探讨甲状腺功能亢进(简称甲亢)孕妇血清促甲状腺素受体抗体(thyrotrophin receptor antibody,TRAb)、促甲状腺素(thyroid stimulating hormone,TSH)、三碘甲状腺原氨酸(triiodothyronine,T3)、四碘甲状腺原氨酸(tetraiodothyronine,T4)水平变化与胎儿生长受限(fetal growth restriction,FGR)的相关性。方法纳入2020年4月—2023年4月郑州市妇幼保健院收治的甲亢孕妇76例为甲亢组,根据1∶1选例原则,另选取同期健康孕妇76例为对照组。比较两组不同时间点血清TRAb、TSH、T3、T4水平,比较正常生长胎儿及生长受限胎儿不同时间点孕妇血清各指标水平及胎儿体重、腹围,分析血清各指标水平与胎儿体重、腹围的相关性。结果甲亢组孕中期、孕晚期及分娩前血清TRAb水平为(18.39±3.68)IU/L、(13.85±2.97)IU/L及(8.10±2.14)IU/L,T3水平为(9.27±2.01)nmol/L、(6.87±1.56)nmol/L及(3.45±0.81)nmol/L,T4水平为(201.56±23.05)nmol/L、(177.23±18.31)nmol/L及(134.62±16.59)nmol/L,均高于对照组,差异具有统计学意义(P<0.05);甲亢组孕中期、孕晚期及分娩前血清TSH水平为(0.22±0.06)mIU/mL、(0.59±0.14)mIU/mL及(1.57±0.48)mIU/mL,均低于对照组,差异具有统计学意义(P<0.05);生长受限胎儿孕中期、孕晚期及分娩前血清TRAb水平为(25.20±3.81)IU/L、(17.24±3.49)IU/L及(11.72±2.80)IU/L,T3水平为(11.75±2.21)nmol/L、(10.14±1.98)nmol/L及(4.94±1.06)nmol/L,T4水平为(238.60±23.75)nmol/L、(210.18±20.86)nmol/L及(160.49±19.21)nmol/L,均高于正常生长胎儿,差异具有统计学意义(P<0.05);生长受限胎儿孕中期、孕晚期及分娩前血清TSH水平为(0.14±0.04)mIU/mL、(0.31±0.09)mIU/mL及(0.98±0.32)mIU/mL,均低于正常生长胎儿,差异具有统计学意义(P<0.05);生长受限胎儿孕中期、孕晚期及分娩前体重为(608.39±30.11)g、(1206.19±124.07)g及(2213.58±267.15)g,腹围为(18.69±1.20)cm、(21.40±1.25)cm及(29.72±1.06)cm,均低于正常生长胎儿,差异具有统计学意义(P<0.05);甲亢孕妇不同时间点血清TRAb、T3、T4水平与胎儿体重、腹围均呈负相关,血清TSH水平与胎儿体重、腹围均呈正相关,差异具有统计学意义(P<0.05)。结论妊娠期血清TRAb、TSH、T3、T4水平与甲亢发生密切相关,且各指标水平与胎儿体重、腹围具有一定相关性,可为临床判断FGR提供参考依据。
Objective To investigate the changes of serum thyrotropin receptor antibody(TRAb),thyrotropin(TSH),triiodothyronine(T3)and tetraiodothyronine(T4)levels in pregnant women with hyperthyroidism and their correlation with fetal growth restriction(FGR).Methods Totally 76 pregnant women with hyperthyroidism treated in Zhengzhou Maternal and Child Health Hospital from April 2020 to April 2023 were selected as the hyperthyroidism group,and 76 healthy pregnant women were selected as the control group according to the 1∶1 case selection principle.The levels of serum TRAb,TSH,T3 and T4 were compared between the two groups at different time points,and the levels of serum indicators,fetal weight and abdominal circumference of pregnant women were compared between normal growth fetuses and growth restricted fetuses at different time points,and the correlation between serum indicators and fetal weight and ab-dominal circumference was analyzed.Results In the hyperthyroidism group,the serum TRAb levels in the second trimester,the third trimester and before delivery were(18.39±3.68)IU/L,(13.85±2.97)IU/L and(8.10±2.14)IU/L,respectively.T3 levels were(9.27±2.01)nmol/L,(6.87±1.56)nmol/L and(3.45±0.81)nmol/L,respectively.T4 levels were(201.56±23.05)nmol/L,(177.23±18.31)nmol/L and(134.62±16.59)nmol/L in the observation group,which were higher than those in the control group,and the differences were statistically significant(P<0.05).The serum TSH levels of the hyperthyroidism group during the second trimester,the third trimester and before delivery were(0.22±0.06)mIU/mL,(0.59±0.14)mIU/mL and(1.57±0.48)mIU/mL,which were lower than those of the control group,and the difference was statistically significant(P<0.05).The serum TRAb levels of fetuses with growth restriction in second trimester,third trimester and before delivery were(25.20±3.81)IU/L,(17.24±3.49)IU/L and(11.72±2.80)IU/L,respectively.T3 levels were(11.75±2.21)nmol/L,(10.14±1.98)nmol/L and(4.94±1.06)nmol/L,respectively.T4 levels were(238.60±23.75)nmol/L,(210.18±20.86)nmol/L and(160.49±19.21)nmol/L,which were higher than those of normal growth fetuses(P<0.05).The serum TSH levels of fetuses with growth restriction in the second trimester,the third trimester and before delivery were(0.14±0.04)mIU/mL,(0.31±0.09)mIU/mL and(0.98±0.32)mIU/mL,which were lower than those of normal growth fetuses,and the difference was statistically significant(P<0.05).The weight of fetuses with growth restriction in the second trimester,the third trimester and before delivery were(608.39±30.11)g,(1206.19±124.07)g and(2213.58±267.15)g,and the abdominal circumference were(18.69±1.20)cm,(21.40±1.25)cm and(29.72±1.06)cm.They were lower than those of normal growth fetuses,and the difference was statistically significant(P<0.05).The serum levels of TRAb,T3 and T4 in pregnant women with hyperthyroidism at different time points were negatively correlated with fetal weight and abdominal circumference,and the serum level of TSH was positively correlated with fetal weight and abdominal circumference,and the difference was statistically significant(P<0.05).Conclusion The levels of serum TRAb,TSH,T3 and T4 during pregnancy are closely related to the occurrence of hyperthyroidism,and the levels of each index have certain correlation with fetal weight and abdominal circumference,which can provide a reference for clinical judgment of FGR.
作者
孙博
周斌
王冠嘉
吕会娟
SUN Bo;ZHOU Bin;WANG Guan-jia;LYU Hui-juan(Department of Obstetrics,Zhengzhou Maternal and Child Health Hospital,Zhengzhou 450000,China;Department of Ultrasound,Zhengzhou Maternal and Child Health Hospital,Zhengzhou 450000,China)
出处
《医药论坛杂志》
2025年第10期1015-1019,共5页
Journal of Medical Forum
基金
河南省医学科技攻关计划联合共建项目(LHGJ20240936)。
