妊娠甲状腺疾病指南精品.ppt

* * 本课题的工作发现单纯TPOAb阳性可以引起后代智力下降8-11分。 * * * 五、妊娠甲状腺疾病筛查 推荐条款 十一、妊娠期甲状腺疾病筛查 ( Screening ) 11-1 筛查高危妊娠人群有30-80%的甲状腺疾病漏诊 A 11-2 成本效益分析显示，筛查整个妊娠人群优于不筛查 B There is insuf?cient evidence to recommend for or against universal TSH screening at the ?rst trimester visit. Level I-USPSTF 推荐条款 十一、妊娠期甲状腺疾病筛查 ( Screening ) 11-3 根据我国国情，本指南支持国内有条件的医院和妇幼保健部门对妊娠早期妇女开展甲状腺疾病筛查。筛查指标选择血清TSH、FT4、TPOAb。筛查时机选择在妊娠8周以前。本指南支持在怀孕前开展甲状腺指标筛查，经有效治疗后再择机怀孕。 A Because no studies to date have demonstrated a bene?t to treatment of isolated maternal hypothyroximenia, universal FT4 screening of pregnant women is not recommended. Level D-USPSTF 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、政府项目 成本-效益分析：筛查优于不筛查 Thank you For our mothers and children * * Figure 1 illustrates median TSH values and the 2.5th to 97.5thserum TSH percentiles for each trimester of pregnancy, recalculated from eight studies reported between 2004 and 2009 and carried out in women negative for TPO auto antibodies, who were from a population without obvious iodine deficiency and confirms the downward shift of serum TSH values during pregnancy. * * * * * * * 值得关注的是，我国同一地区、同一试剂获得的血清TSH参考值上下限和中位数均呈现上升的趋势。本课题组1999年在沈阳市参考值人群获得TSH参考值是0.29-4.74 mIU/L（n=1964，DPC试剂），2007年0.46-5.19 mIU/L （n=2118，DPC试剂），而2010年升高至0.50-5.67 mIU/L（n=991，DPC试剂）（内部资料，未发表）。 * * * * * * * * * * * * * * * 妊娠16-20周母亲低T4血症组后代智力评分比对照组后代低9.30分（p=0.004），运动评分低7.57分（p=0.007）。 * FIG. 3. Top, TSH values during gestation in group A (TPOAb treated with LT4), group B (TPOAb), and group C (TPOAb). At 10 wk, groups A and B were higher than group C; at 20 and 30 wk and after delivery, groups A and C were lower than group B. Bottom, FT4 values during gestation. At 30 wk and after delivery, groups A and C were higher than group B. , P 0