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目的 对产后甲状腺炎(PPT)进行大样本的流行病学调查。方法 610例辽宁省沈阳市产妇进入队列研究, 488例(80% )随访6个月以上。进入队列的产妇均在分娩前、产后3个月和6个月时留取空腹血清,应用固相免疫化学发光酶免法测定血清TSH、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、游离T4 (FT4 )、游离T3 (FT3 )和甲状腺球蛋白(Tg),应用酶联免疫吸附法测定TSH受体抗体(TRAb)。同时进行体格检查和甲状腺B超检查。产后6个月内血清TSH异常的产妇继续接受产后9个月和12个月的随访。结果 488例产妇中发现58例PPT, 患病率为11. 88%, 其中临床PPT35例(7. 17% ),亚临床PPT23例(4. 71% );产后Graves病3例,患病率为0. 62%。年龄、孕产次数和新生儿性别对PPT的患病率无显著影响。临床PPT患者中单纯甲亢型占45. 7%,单纯甲减型占11. 4%,甲亢甲减期双相型占42. 9%,在产后12个月时仍有甲减者占8. 6%; 亚临床PPT患者中单纯亚临床甲亢型占65. 2%,单纯亚临床甲减型占34. 8%,无双相型表现。PPT患者的TPOAb阳性率显著高于非PPT产妇(P<0. 01);TPOAb阳性者PPT患病危险性显著高于TPOAb阴性者(RR=6. 76, 95%CI4. 42 ~10. 34);患者在产后6个月时TPOAb滴度达到高峰, 临床PPT患者的TPOAb滴度显著高于亚临床PPT患者(P<0. 01
OBJECTIVE: To conduct a large sample epidemiological survey of postpartum thyroiditis (PPT). Methods A total of 610 males from Shenyang, Liaoning Province, were included in the cohort study. 488 (80%) were followed up for more than 6 months. The women who entered the cohort were given fasting serum before delivery, 3 months and 6 months postpartum, and serum TSH, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody TSA receptor antibody (TRAb) was measured by enzyme-linked immunosorbent assay (TgAb), free T4 (FT4), free T3 (FT3) and thyroglobulin (Tg) At the same time physical examination and thyroid B-ultrasound. Maternal post-partum 6-month serum TSH abnormalities continue to be followed up for 9 months and 12 months postpartum. Results 588 PPTs were found in 488 mothers, the prevalence was 11.88%, of which 35 cases were clinical PPT (7.3%) and 23 cases were subclinical PPT (4.71%). Postpartum Graves’ disease was found in 3 cases, 62%. Age, number of pregnancies and neonatal gender had no significant effect on the prevalence of PPT. Clinical hypothyroidism accounted for 45.7% of patients with pure PPT, simple hypothyroidism accounted for 11.4%, hyperthyroidism hypothyroidism accounted for 42. 9% bipolar, 12 months after delivery there are still hypothyroidism accounted for 8%. 6%; subclinical PPT patients in subclinical hyperthyroidism accounted for 65.2%, subclinical hypothyroidism accounted for 34.8%, no bipolar performance. The prevalence of TPOAb in PPT patients was significantly higher than that in non-PPT mothers (P <0.01). The risk of PPT in TPOAb-positive patients was significantly higher than that in TPOAb-negative patients (RR = 6.66, 95% CI4.42-10.34 ). The TPOAb titers reached a peak at 6 months postpartum, and the TPOAb titers in clinical PPT patients were significantly higher than those in subclinical PPT patients (P <0.01)