康苏娅，汪云



·论著·

妊娠期亚临床甲状腺功能减退症与贫血的相关性研究

康苏娅，汪云

目的：探讨妊娠期亚临床甲状腺功能减退症（SCH）与贫血之间的关系及治疗是否能改善妊娠期贫血的发生率。方法：选择SCH孕妇1 087例为SCH组；甲状腺功能正常孕妇4 942例为对照组（均排除妊娠早期贫血）。SCH组按是否愿接受药物治疗，分为SCH-治疗组和SCH-未治组，比较SCH组与对照组的甲状腺过氧化物酶抗体（TPOAb）阳性率，根据妊娠晚期血常规检查结果，比较各组的贫血发生率。结果：①SCH组的TPOAb阳性率高于对照组，差异有统计学意义（23.4%vs.9.4%，χ2=163.920，P=0.000）。②妊娠晚期SCH组贫血发生率高于对照组，差异有统计学意义（25.4%vs.21.0%，χ2=9.459，P=0.002）。SCH-治疗组的贫血发生率低于SCH-未治组，但差异无统计学意义（22.9%vs.26.5%，P=0.204）。结论：SCH会增加孕妇妊娠晚期贫血的发病风险，给予左旋甲状腺激素（LT4）有利于降低SCH孕妇的贫血发生率。

甲状腺素；甲状腺功能减退症；贫血；发病率；孕妇

【Abstract】Objective:To investigate the relationship between subclinical hypothyroidism（SCH）during pregnancy and maternity anemia in late gestation，and to analyze if the treatmentwith oral levothyroxine（LT4）can improve the incidence of anemia.M ethods：1 087 gravidas with SCH（the SCH group）and 4 942 gravidas with normal thyroid function（the control group）diagnosed by the serum thyroid function screening during prenatal care were included in this retrospective case-control study.All gravidas with the anemia during early pregnancy were excluded.The SCH group were then divided into the SCH-treated subgroup and the SCH-untreated subgroup according to whether they were treated with LT4.The positive rate of TPOAb and the incidence of anemia were compared among groups.Results：①The positive rate of TPOAb in the SCH group was significantly higher than that in the controlgroup（23.4%vs.9.4%，χ2=163.920，P=0.000）.②The incidence of anemia in the SCH group was significantly higher than that in the control group（25.4%vs.21.0%，χ2=9.459，P=0.002），while this incidence in the SCH-treated subgroup was lower than that in the SCH-untreated subgroup（22.9%vs.26.5%，but P=0.204）. Conclusions：SCH increases the incidence of anemia during last trimester in gestation period.LT4 treatmentmay improve the incidence of SCH-maternity anemia in late gestation.

【Keywords】Thyroxine；Hypothyroidism；Anemia；Incidence；Pregnantwomen

（JIntReprod Health/Fam Plan，2016，35：292-294）

贫血尤其是缺铁性贫血是妊娠期最常见的并发症之一，其发病率较高，会对孕妇自身及胎儿的健康造成严重的影响［1］。亚临床甲状腺功能减退症（subclinicalhypothyroidism，SCH）是指血清促甲状腺素（thyroid-stimulating hormone，TSH）水平超过正常参考值上限，而游离甲状腺素（free thyroxine，FT4）仍正常的情况，常伴甲状腺抗体阳性，亦为妊娠期常见疾病。有研究发现，SCH可造成母胎不良结局，各种妊娠并发症的发生率也明显增加［2］。SCH合并贫血对母儿的不良影响可能比单一疾病更大，更应引起重视。关于是否需要治疗SCH，尤其是否对甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）阴性的SCH孕妇使用左旋甲状腺激素（LT4）治疗，仍存在很大争议［3］。……