摘要目的 调查妊娠中期甲状腺功能减退症(简称甲减)的检出率,探讨甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)与妊娠中期甲减的关系. 方法 对2010年3月1日至7月31日在上海交通大学医学院附属国际和平妇幼保健院产科门诊产前检查的孕14～28周孕妇2141例进行横断面调查,检测其血清TPOAb、促甲状腺激素(thyroid-stimulating hormone,TSH)和血清游离甲状腺素(free thyroxine,FT4)水平.TPOAb阳性和亚临床甲减影响因素分析采用二分类Logistic回归,TPOAb水平与TSH、FT4的相关性分析使用Spearman秩相关分析. 结果 (1)妊娠中期亚临床甲减检出率13.36％(286/2141),低T4血症检出率0.14％ (3/2141),未检出临床甲减患者.(2)以TPOAb≥50 U/ml为阳性,2141例孕妇中TPOAb阳性者为134例,占6.26％.亚临床甲减患者、低T4血症患者和甲状腺功能正常孕妇TPOAb阳性分别为13.64％ (39/286)、0/3和5.06％(86/1701),组间比较差异有统计学意义(x2=30.82,P＜0.01).妊娠中期TPOAb阳性不受孕次、产次、孕周、胎儿性别及孕母年龄的影响.(3) TPOAb水平与TSH值呈正相关(r=0.12,P＜0.01),与FT4值无相关性(r=-0.04,P=0.09).(4)血清TPOAb阳性和孕次是妊娠中期亚临床甲减的危险因素(OR=3.18,95％ CI:2.10～4.83,P＜0.01；OR=1.21,95％ CI:1.02～1.43,P=0.030). 结论 亚临床甲减是妊娠中期的常见疾病,TPOAb是亚临床甲减的独立危险因素和重要预测指标.应当关注妊娠中期甲减的筛查,同时将TPOAb检测纳入常规产前筛查项目.

abstractsObjective To investigate the prevalence of hypothyroidism during the second trimester and its relationship with thyroid peroxidase antibody (TPOAb). Methods Two thousand one hundred and forty one pregnant women whose gestational age between 14 to 28 weeks,accepted their prenatal care at the outpatient clinic of International Peace Maternity & Child Health Hospital from March 1,2010 to July 31,2010 were enrolled into this study. Serum TPOAb,thyroidstimulating hormone (TSH) and free thyroxine (FT4) of these women were detected. Logistic regression model was used to analyze the risk factors of subclinical hypothyroidism and positive TPOAb,while Spearman rank correlation was used to analyze the relationship between the levels of TSH,FT4 and TPOAb. Results (1) Subclinical hypothyroidism was detected in 13.36％ (286/2141) patients. Isolated maternal hypothyroxinemia occurs in 0.14％ (3/2141) of pregnant women.No overt hypothyroidism patient was detected and 6.26％ (134/2141) of all pregnant women exhibited positive TPOAb(≥50 U/ml).(2) Positive rate of TPOAb in subclinical hypothyroidism group,isolated maternal hypothyroxinemia group and normal thyroid function group was 13.64％ (39/286),0/3 and 5.06％ (86/1701) respectively,and there was difference among the three groups (x2 =30.82,P＜0.01).The positive rate of TPOAb did not relate to fetal gender,maternal age,gestational age,gravidity and parity.(3) TPOAb had positive relationship with TSH level (r=0.12,P＜0.01),while did not relate to FT4 level (r=-0.04,P=0.09). (4) Positive TPOAb (OR 3.18,95％ CI:2.10-4.83,P＜0.01) and gravidity (OR=1.21,95％ CI:1.02-1.43,P=0.030)were risk factors of subclinical hypothyroidism. Conclusions Hypothyroidism is common during the second trimester. It is necessary to screen TPOAb in pregnant women as TPOAb is an independent and important predictor of subclinical hypothyroidism.