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目的探讨妊娠早中期亚临床甲减对后代甲状腺功能和智力发育的影响。方法选择2013年1月至2015年1月福建医科大学附属宁德市医院产科收治的妊娠早中期合并亚临床甲减的孕妇55例,其中甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性组35例,TPOAb阴性组20例,单纯TPOAb阳性组30例,健康妊娠者30例为对照组。测定4组孕妇20~30月龄子代的甲状腺功能游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、促甲状腺激素(thyroid stimulating hormone,TSH),随访20~30月龄子代的发育商指标,比较4组婴儿有无差异。结果亚临床甲减+TPOAb(+)组、亚临床甲减+TPOAb(-)组、单纯TPOAb(+)组子代TSH水平显著高于对照组,血清FT_3、FT_4水平明显低于对照组(P<0.05);亚临床甲减+TPOAb(+)组子代发育商低于其余各组,其中智力显著低于亚临床甲减+TPOAb(-)组和对照组(P<0.05),而亚临床甲减+TPOAb(+)组与单纯TPOAb(+)组发育商比较差异无统计学意义(P>0.05)。结论妊娠早中期亚临床甲减可能引起子代短期的甲状腺功能异常,亚临床甲减伴TPOAb(+)可能对子代神经系统发育造成影响,妊娠期单纯TPOAb(+)也可能会对子代神经智力与运动发育造成一定影响。建议对妊娠早期母体进行TPOAb的广泛筛查,如出现促甲状腺激素增高,应及时治疗。
Objective To investigate the effect of subclinical hypothyroidism (Hypothyroidism) on the thyroid function and mental development in the offspring in early and middle gestation. Methods Fifty-five pregnant women with subclinical hypothyroidism during the first and second trimester of pregnancy admitted to the Ningde Hospital Affiliated to Fujian Medical University from January 2013 to January 2015 were selected, of which thyroid peroxidase antibody (TPOAb) positive group 35 cases, TPOAb negative group 20 cases, simple TPOAb positive group 30 cases, healthy pregnancy 30 cases as control group. The thyroid function of free triiodothyronine (FT_3), free thyroxine (FT_4) and thyroid stimulating hormone (TSH) were measured in 20-30-month-old offsprings of 4 groups of pregnant women, 20-30 months offspring of the development of business indicators, compared with 4 groups of infants or no difference. Results TSH levels in subclinical hypothyroidism + TPOAb (+) group, subclinical hypothyroidism + TPOAb (-) group and TPOAb (+) group were significantly higher than those in control group, serum FT_3 and FT_4 levels were significantly lower than those in control group (P <0.05). The subclinical hypothyroidism + TPOAb (+) group had lower developmental quotient than the other groups, and the intelligence was significantly lower in subclinical hypothyroidism + TPOAb (-) group and control group (P <0.05) There was no significant difference in subclinical hypothyroidism + TPOAb (+) group and TPOAb (+) group alone (P> 0.05). Conclusion Subclinical hypothyroidism may cause short-term hypothyroidism in the offspring. Subclinical hypothyroidism with TPOAb (+) may have an impact on the development of the offspring’s nervous system. Gestational TPOAb (+) may also affect offspring Neurological intelligence and exercise development have a certain impact. It is recommended that the matrix of TPOAb should be extensively screened in the first trimester of pregnancy. If thyroid stimulating hormone is present, it should be treated promptly.