MMC中心优秀研究汇展⑤|妊娠期亚临床甲状腺功能减退患者产后甲状腺功能随访
上海交通大学医学院附属第一人民医院内分泌代谢科李娜医生为第一作者,上海交通大学医学院附属第一人民医院内分泌代谢科王育璠教授为通信作者。
图1:文章标题和作者
简介
根据2017年美国甲状腺协会(ATA)指南,妊娠期亚临床甲状腺功能减退症(SCH)的定义是促甲状腺激素(TSH)升高超过妊娠特异性参考范围的上限且游离甲状腺素(fT4)水平正常。先前的研究表明,妊娠期SCH的患病率在 4 %和25%之间变化,具体取决于孕期特定的TSH参考范围。几项研究表明,妊娠期SCH与不良妊娠和围产期结局相关。2017年ATA指南建议使用左旋甲状腺素(LT4)治疗以将TSH值保持在参考下限和 2.5 mU/L之间。然而,指南中并未具体提及SCH孕妇的产后甲状腺状况和产后管理。
摘要
背景:
妊娠期亚临床甲状腺功能减退症(SCH)与不良妊娠和围产期结局相关。然而,很少有研究调查这些女性产后甲状腺功能的演变。本研究旨在确定妊娠期SCH的产后结局以及与长期甲状腺功能减退症演变相关的临床和生化因素。
结果:妊娠期SCH分娩后长期甲状腺功能减退的概率为 38.9 %。在产后6周甲状腺功能正常的受试者中,28.2 %在长期随访期间出现甲状腺功能减退。LMM显示SCH诊断时的孕周(估计值:-0.018,p=0.004)和甲状腺过氧化物酶抗体(TPOAb)(估计值:0.001,p=0.020)与TSH的纵向变化显著相关。逻辑回归模型显示,妊娠期间和产后 6 周TPOAb阳性是分娩后长期甲状腺功能减退的危险因素(优势比=4.686[95%置信区间1.242至17.680],p=0.023)。
结论:
超过三分之一的妊娠期SCH患者在分娩后出现持续性甲状腺功能减退。我们建议在怀孕期间和产后 6 周内对TPOAb阳性的患者进行密切随访,以检测持续性甲状腺功能减退,尤其是在下一次怀孕之前。
附英文摘要(滑动查看):
Abstract
Background:
Subclinical hypothyroidism(SCH)in pregnancy is associated with adverse pregnancy and perinatal outcomes.However,few studies have investigated the evolution of postpartum thyroid function in these women.This study aimed to determine the postpartum outcomes of SCH during pregnancy and the clinical and biochemical factors related to the evolution of long-term hypothyroidism.Method:A total of 393 women diagnosed with SCH during pregnancy(defined as thyrotropin[TSH]>4.0μIU/mL with normal free thyroxine levels according to the 2017 American Thyroid Association guidelines)were prospectively followed up after delivery.Among them,216 underwent long-term follow-up[median(interquartile range)follow-up time:11(7~19)months]postpartum.The clinical and biochemical characteristics of the women with long-term postpartum hypothyroidism and euthyroidism were compared.Linear mixed model(LMM)was used to explore the risk factors for longitudinal changes of TSH,and logistic regression analysis was employed to identify the independent predictors of long-term postpartum hypothyroidism.
Results:The probability of long-term hypothyroidism after delivery in SCH during pregnancy was 38.9%.Among the subjects with normal thyroid function 6-week postpartum,28.2%developed hypothyroidism during long-term follow-up.The LMM showed that gestational age at the time of SCH diagnosis(estimate:−0.018,p=0.004)and thyroid peroxidase antibodies(TPOAb)(estimate:0.001,p=0.020)were significantly associated with longitudinal changes of TSH.The logistic regression model showed that TPOAb positive both during pregnancy and six-week postpartum was a risk factor for long-term hypothyroidism after delivery(odds ratio=4.686[95%confidence interval 1.242 to 17.680],p=0.023).
Conclusions:More than one-third of patients with SCH during pregnancy had persistent hypothyroidism after delivery.We recommend that patients with TPOAb positive both during pregnancy and six-week postpartum undergo close follow-up to detect persistent hypothyroidism,especially before the next pregnancy.
通信作者
• 医学博士,博士研究生导师
• 主要研究方向为妊娠合并内分泌疾病及产后管理、糖尿病区域管理
• 担任中华医学会内分泌学分会糖尿病学组、中华医学会糖尿病分会妊娠糖尿病学组、上海市医学会内分泌分会委员兼秘书、世界临床药物杂志编委等
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