摘要
目的探讨血清甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))/游离甲状腺素(free thyroxine,FT_(4))、促甲状腺激素(thyroid stimulating hormone,TSH)水平对妊娠期甲状腺功能减退症患者妊娠结局的预测价值。方法选取2020年1月至2024年4月于佛山市南海区第五人民医院诊断为妊娠期甲状腺功能减退症的83例孕妇为研究对象,按照甲状腺功能减退的类型分为观察组A(亚临床甲状腺功能减退,n=47)与观察组B(临床甲状腺功能减退,n=36);另选取同期于本院产检的50名甲状腺功能正常孕妇作为健康组。检测并比较3组血清TPOAb、TSH、FT_(3)、FT_(4)水平与FT_(3)/FT_(4)值;统计妊娠期甲状腺功能减退症孕妇妊娠结局,比较不良妊娠结局与正常妊娠结局孕妇的临床资料及血清TPOAb、TSH水平与FT_(3)/FT_(4)值;采用多因素Logistic回归分析妊娠期甲状腺功能减退症孕妇不良妊娠结局的影响因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估TPOAb、TSH水平与FT_(3)/FT_(4)值单一检测及联合检测对不良妊娠结局的预测价值。结果观察组B血清TPOAb、TSH水平均高于观察组A、健康组,且观察组A高于健康组,观察组B FT_(3)、FT_(4)水平及FT_(3)/FT_(4)均低于观察组A、健康组,且观察组A低于健康组,差异有统计学意义(P<0.05)。83例妊娠期甲状腺功能减退患者中,发生不良妊娠结局18例,发生率为21.69%;不良妊娠结局孕妇TPOAb、TSH水平均高于正常妊娠结局孕妇,FT_(3)/FT_(4)低于正常妊娠结局孕妇,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,TPOAb与TSH升高及FT_(3)/FT_(4)降低均为妊娠期甲状腺功能减退患者发生不良妊娠结局的独立危险因素(P<0.05)。ROC曲线结果显示,TPOAb、FT_(3)/FT_(4)及TSH联合预测不良妊娠结局的曲线下面积、灵敏度、特异度分别为0.944、91.45%、94.66%。结论血清TPOAb、FT_(3)/FT_(4)与TSH水平在妊娠期甲状腺功能减退症患者不良妊娠结局的预测中具有重要意义,联合检测可显著提高预测准确性。
Objective To explore the predictive value of serum thyroid peroxidase antibody(TPOAb),free triiodothyronine(FT_(3))/free thyroxine(FT_(4))and thyroid stimulating hormone(TSH)levels for the pregnancy outcome in patients with hypothyroidism during pregnancy.Methods A total of 83 pregnant women diagnosed with gestational hypothyroidism in the Fifth People's Hospital of Nanhai District,Foshan City from January 2020 to April 2024 were selected as the research subjects,they were and divided into the observation group A(subclinical hypothyroidism,n=47)and the observation group B(clinical hypothyroidism,n=36)according to the types of hypothyroidism.50 pregnant women who underwent pregnancy physical examinations during the same period and showed normal thyroid function were selected as the healthy group.The levels of serum TPOAb,TSH,FT_(3),FT_(4)and FT_(3)/FT_(4)were detected and compared among the three groups;the pregnancy outcomes of pregnant women with hypothyroidism during pregnancy were statistically analyzed,the clinical data,serum TPOAb,TSH levels and FT_(3)/FT_(4)values of pregnant women with adverse pregnancy outcomes and normal pregnancy outcomes were compared,multivariate Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy,and the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of single and combined detection of TPOAb,TSH levels and FT_(3)/FT_(4)values for adverse pregnancy outcomes.Results The levels of serum TPOAb,TSH in the observation group B were higher than those in the observation group A and the healthy group,and the observation group A was higher than the healthy group,while the levels of FT_(3)and FT_(4)and FT_(3)/FT_(4)in the observation group B were lower than those in the observation group A and the healthy group,and the observation group A was lower than the healthy group,the differences were statistically significant(P<0.05).Among 83 patients with hypothyroidism during pregnancy,18 cases had adverse pregnancy outcomes,with the incidence rate of 21.69%.The levels of TPOAb and TSH in the pregnant women with adverse pregnancy outcomes were higher than those in the pregnant women with normal pregnancy outcomes,and the FT_(3)/FT_(4)were lower than those in the pregnant women with normal pregnancy outcomes,the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that the increase of TPOAb and TSH and the decrease of FT_(3)/FT_(4)were independent risk factors for adverse pregnancy outcomes in patients with hypothyroidism during pregnancy(P<0.05).The results of the ROC curve showed that the area under the curve,sensitivity and specificity of the combined prediction of pregnancy outcomes by TPOAb,FT_(3)/FT_(4)and TSH were 0.944,91.45%and 94.66%,respectively.Conclusion Serum levels of TPOAb,FT_(3)/FT_(4),and TSH are of great significance in predicting adverse pregnancy outcomes in patients with hypothyroidism during pregnancy,and their combined application can significantly improve prediction accuracy.
作者
彭伟媛
魏琼
林海山
PENG Weiyuan;WEI Qiong;LIN Haishan(Department of Laboratory Medicine,Fifth People's Hospital of Nanhai District,Foshan,Guangdong,528200,China)
出处
《当代医学》
2025年第3期77-81,共5页
Contemporary Medicine
