妊妊娠和产后甲状腺疾病诊治指南.ppt

* * * * * * * 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）。 * 2007年美国内分泌学会“妊娠期和产后甲状腺功能异常的处理指南”指出： 妊娠合并亚临床甲减将导致产科并发症及胎儿智力发育迟缓 * Casey的研究纳入404例亚临床甲减患者，探讨亚临床甲减对于母体不良结局及胎儿不良结局的风险。结果亚临床甲减的妊娠女性早产（34周）风险是正常者的3倍(relative risk 3.0, 95% confidence interval 1.1– 8.2). ，胎盘早剥是正常者的1.8倍 (relative risk, 1.8, 95% confidence interval1.1–2.9).而对于胎儿的影响也十分显著，母亲是亚临床甲减者，新生儿入住监护室的概率是母亲正常者的1.8倍(relative risk, 1.8, 95% confidence interval1.1–2.9).；新生儿呼吸窘迫综合征患病率是母亲是正常者的1.8倍(relative risk, 1.8, 95% confidence interval1.1–3.3). BACKGROUND: 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. Weundertook 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 were retrospectively identified with subclinical hypothyroidism. Pregnancy outcomes were compared with those in pregnant women with normal TSH values between the 5th and 95th percentiles. RESULTS: A total of 25,756 women underwent thyroid screening and were delivered of a singleton infant. There were 17,298 (67%) women enrolled for prenatal care at 20 weeks of gestation or less, and 404 (2.3%) of these were considered to have subclinical hypothyroidism. Pregnancies in women with subclinical hypothyroidism were 3 times more likely to be complicated by placental a