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目的探讨妊娠期甲状腺疾病临床筛查指标及亚临床甲状腺功能减退症对妊娠结局的影响。方法选取2013年10月-2015年10月在该院行妊娠期甲状腺疾病筛查的孕妇1 027例,根据促甲状腺激素水平分为两组,对照组(715例)促甲状腺激素处于正常水平,观察组(312例)促甲状腺激素处于高水平。分析两组临床筛查指标阳性情况,比较两组临床检验指标及妊娠结局。结果观察组临床筛查指标(体重增长异常、心血管症状、消化道症状、免疫性疾病、甲状腺疾病家族史、超声提示胎儿偏小)阳性率均明显高于对照组(P<0.05)。随着妊娠时间延长,对照组及观察组血清游离甲状腺素(FT4)均呈现出不同程度下降态势。观察组血清游离甲状腺素在孕早期、孕中期及孕晚期时均明显低于对照组(P<0.05)。观察组孕妇剖宫产率、妊娠期高血压疾病、妊娠期糖尿病、羊水异常、胎膜早破及产后出血发生率均明显高于对照组,差异有统计学意义(P<0.05)。观察组新生儿低体重、胎儿宫内窘迫、胎儿畸形及早产儿发生率均明显高于对照组,差异有统计学意义(P<0.05)。结论亚临床甲状腺功能减退症可引发妊娠期并发症,对妊娠结局有一定影响,及早行甲状腺功能筛查具有重要的临床意义。
Objective To investigate the clinical screening of thyroid disease in pregnancy and subclinical hypothyroidism on pregnancy outcome. Methods A total of 1 027 pregnant women with thyroid disease screening during pregnancy from October 2013 to October 2015 in our hospital were divided into two groups according to thyrotropin levels. The thyroid-stimulating hormone in the control group (715 cases) was at normal level, Observation group (312 cases) thyrotropin at a high level. The positive results of two groups of clinical screening indicators were analyzed, and the clinical test indexes and pregnancy outcomes were compared between the two groups. Results The positive rate of clinical screening indicators (abnormal weight gain, cardiovascular symptoms, gastrointestinal symptoms, immune diseases, family history of thyroid diseases, small fetuses by ultrasound) were significantly higher in the observation group than those in the control group (P <0.05). With the prolongation of pregnancy, serum free thyroxine (FT4) in the control group and observation group showed a downward trend in varying degrees. The level of serum free thyroxine in the observation group was significantly lower than that of the control group (P <0.05) during the first trimester, the second trimester and the third trimester of pregnancy. Cesarean section rate, hypertensive disorder complicating pregnancy, gestational diabetes mellitus, amniotic fluid abnormality, premature rupture of membranes and the incidence of postpartum hemorrhage in observation group were significantly higher than those in control group (P <0.05). The incidence of neonatal low birth weight, fetal distress, fetal malformation and premature infants in observation group were significantly higher than those in control group (P <0.05). Conclusion Subclinical hypothyroidism may trigger complications during pregnancy, which may have some impact on pregnancy outcome. Early thyroid function screening has important clinical significance.