单忠艳妊娠甲状腺教案分析.ppt

* * 成本效益（Cost-effectiveness）分析 用Markov状态转移模型对不筛查、筛查TSH、筛查TPOAb三个模式做成本效益分析 结果发现，对妊娠早期妇女进行TSH和TPOAb的筛查，在治疗花费及预防可能存在的不良结局方面都具有较高的成本效益 Dosiou C,. 2008 Eur J Endocrinol. Jun;158(6):841-51 普遍筛查的理由 育龄妇女高发：最近完成的《十城市甲状腺疾病和碘营养状况调查》显示，育龄妇女（n=4438）的临床甲减、亚临床甲减和TPOAb阳性的患病率分别为0.77%，5.32%，12.96% 妊娠妇女高发：我国妊娠前半期妇女筛查临床甲减、亚临床甲减和TPOAb的患病率分别为0.6%、5.27%和8.6%； 负面作用：妊娠妇女临床甲减、亚临床甲减和TPOAb阳性对妊娠结局和后代神经智力发育存在不同程度的负面影响； 筛查的理由 诊断手段：血清TSH、FT4、TPOAb，价格便宜，广泛可得，指标可靠 治疗手段：L-T4 经济、有效、安全 患者筛查治疗意愿强烈：我国的国情 成本-效益分析：筛查优于不筛查 免费孕前优生健康检查项目 2012年《政府工作报告》中指出：“将免费孕前优生健康检查试点范围扩大至60%的县（市、区） 检查项目（15项）： 阴道分泌物 血常规 尿常规 血型 血糖 肝功能 乙肝五项 肌酐 甲状腺功能 梅毒螺旋体 巨细胞病毒抗体 弓形体抗体 风疹病毒 妇科超声 Thank you For mothers and children * * * * * * * 14: Obstet Gynecol. 2005 Feb;105(2):239-45.Related Articles, Links ?Comment in: Obstet Gynecol. 2005 Feb;105(2):235-6. Obstet Gynecol. 2005 Jul;106(1):198; author reply 198-9. Subclinical hypothyroidism and pregnancy outcomes.Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG.Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA. brian.casey@utsouthwestern.eduBACKGROUND: Clinical thyroid dysfunction has been associated with pregnancy complications such as hypertension, preterm birth, low birth weight, placental abruption, and fetal death. The relationship between subclinical hypothyroidism and pregnancy outcomes has not been well studied. We undertook this prospective thyroid screening study to evaluate pregnancy outcomes in women with elevated thyrotropin (thyroid-stimulating hormone, TSH) and normal free thyroxine levels. METHODS: All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, had thyroid screening using a chemiluminescent TSH assay. Women with TSH values at or above the 97.5th percentile for gestational age at screening and with free thyroxine more than 0.680 ng/dL wer