甲状腺功能异常孕产妇发生稽留流产的临床分析

Clinical Analysis of Mifepristone Abortion in Pregnant Women with Abnormal Thyroid Function

摘要: 目的：分析甲状腺功能异常孕产妇与稽留流产发生的关系，为临床诊疗提供依据。方法：选择从2016年3月至2017年3月于我院就诊的150例稽留流产孕妇作为研究组，另选择同时期常规产检的150例正常孕妇作为对照组。观察两组孕妇甲状腺激素及抗体水平{游离T4 (FT4)，促甲状腺激素(TSH)，甲状腺球蛋白过氧化物酶抗体(TPOAb)}情况，统计甲状腺功能异常孕妇与稽留流产发生的相关性。结果：研究组孕妇的FT4，TSH及TPOAb分别为(8.45 ± 1.35) pmol/l，(4.53 ± 1.37) uIU/l及(55.42 ± 6.38) IU/l，对照组孕妇为(14.92 ± 1.38) pmol/l，(1.12 ± 1.38) uIU/l及(28.44 ± 6.36) IU/l，两组比较，差异具有明显统计学意义(P < 0.05)。研究组孕妇的亚临床甲状腺功能减退症和TPOAb阳性检出率分别为26.25%和15.00%，对照组孕妇为7.50%和3.75%，两组比较，差异具有明显统计学意义(P < 0.05)。稽留流产孕妇与亚临床甲状腺功能减退症具有明显关联性(OR = 4.39，95%CI为2.99~5.64)，稽留流产孕妇和TPOAb阳性也具有明显关联性(OR = 4.53，95%CI为2.12~5.66)。结论：甲状腺功能检查主要用于判断孕妇体内甲状腺激素水平并用于甲状腺疾病的诊断。稽留流产是在早孕期胚胎死亡或胚胎停止发育后未自然排出者。稽留流产孕妇的FT4，TSH及TPOAb测定明显异于正常孕妇，临床上应对合并亚临床甲状腺功能减退症和TPOAb阳性的孕妇高度关注，积极处理，降低稽留流产的发生。积极开展孕前及妊娠早期甲状腺功能相关检查，及早发现并治疗亚临床甲状腺功能减退症对降低稽留流产的发生率有一定临床意义。

Abstract: Objective: To analyze the relationship between pregnant women with abnormal thyroid function and mifepristone abortion, and to provide basis for clinical diagnosis and treatment. Methods: 150 pregnant women with mifepristone abortion from March 2016 to March 2017 were selected as the study group, and 150 normal pregnant women with regular birth examination were selected as the control group in the same period. The thyroid hormone and antibody levels {free T4 (FT4), thyroid stimulating hormone (TSH), thyroid globulin peroxidase antibody (TPOAb)} in two groups of pregnant women were observed, and the correlation between pregnant women with abnormal thyroid function and the occurrence of mifepristone abortion was counted. Results: The FT4, TSH and TPOAb of pregnant women in the study group were (8.45 ± 1.35) pmol/l, (4.53 ± 1.37) uIU/l and (55.42 ± 6.38) IU/l, and the pregnant women in the control group were (14.92 ± 1.38) pmol/l, (1.12 ± 1.38) uIU/l and (28.44 ± 6.36) IU/l, compared between the two groups, the difference has obvious statistical significance (P < 0.05). The rates of subclinical hypothyroidism and TPOAb pos-itive in pregnant women in the study group were 26.25% and 15%, respectively, 7.5% and 3.75% in the control group, and the difference between the two groups was significantly statistically sig-nificant (P < 0.05). There was a significant correlation between pregnant women with mifepristone abortion and subclinical hypothyroidism (OR = 4.39, 95% CI was 2.99 - 5.64), and there was also a significant correlation between mifepristone abortion pregnant women and TPOAb positive (OR = 4.53, 95% CI 2.12 - 5.66). Conclusion: Thyroid function test is mainly used to judge thyroid hormone level in pregnant women and to be used in the diagnosis of thyroid diseases. Mifepristone miscarriage is a person who is not naturally excreted after the death of an embryo in early pregnancy or when the embryo ceases to develop. The determination of FT4, TSH and TPOAb in pregnant women with mifepristone abortion is obviously different from that of normal pregnant women, and the clinical treatment of pregnant women with subclinical hypothyroidism and TPOAb positive is of great concern, and it is actively treated to reduce the occurrence of mifepristone abortion. To actively carry out thyroid function related examination before and early pregnancy, early detection and treatment of subclinical hypothyroidism has certain clinical significance to reduce the incidence of mifepristone abortion.