朱慧,陈方方,李璐.不同妊娠期妇女血常规参数和甲状腺激素水平的变化及其与甲状腺过氧化物酶抗体的相关性分析[J].上海预防医学,2023,35(12):1227-1231.. doi: 10.19428/j.cnki.sjpm.2023.23041
引用本文: 朱慧,陈方方,李璐.不同妊娠期妇女血常规参数和甲状腺激素水平的变化及其与甲状腺过氧化物酶抗体的相关性分析[J].上海预防医学,2023,35(12):1227-1231.. doi: 10.19428/j.cnki.sjpm.2023.23041
ZHU Hui,CHEN Fangfang,LI Lu.Analysis of changes in routine blood parameters and thyroid hormone levels in women at different stages of pregnancy and their correlations with TPOAb[J].Shanghai Journal of Preventive Medicine,2023,35(12):1227-1231.. doi: 10.19428/j.cnki.sjpm.2023.23041
Citation: ZHU Hui,CHEN Fangfang,LI Lu.Analysis of changes in routine blood parameters and thyroid hormone levels in women at different stages of pregnancy and their correlations with TPOAb[J].Shanghai Journal of Preventive Medicine,2023,35(12):1227-1231.. doi: 10.19428/j.cnki.sjpm.2023.23041

不同妊娠期妇女血常规参数和甲状腺激素水平的变化及其与甲状腺过氧化物酶抗体的相关性分析

Analysis of changes in routine blood parameters and thyroid hormone levels in women at different stages of pregnancy and their correlations with TPOAb

  • 摘要:
    目的 探讨不同妊娠期妇女的血常规参数和甲状腺激素水平的变化规律及其与甲状腺过氧化物酶抗体(TPOAb)三者之间的关联性,为妇儿保健和诊疗提供理论依据。
    方法 选取2020年5月—2022年8月在同济大学附属第一妇婴保健院建档并进行保健检查的 732例不同妊娠期妇女为观察组,包括妊娠早期245例(妊娠≤12周)、妊娠中期247例(12周<妊娠<28周)以及妊娠晚期240例(妊娠≥ 28周)。另选取240例育龄期非妊娠健康体检妇女为对照组。所有对象均留取外周静脉血,进行血红蛋白(Hb)、红细胞分布宽度标准差(RDW⁃SD)、红细胞分布宽度变异系数(RDW⁃CV)、血小板(Plt)计数、血小板分布宽度(PDW)以及促甲状腺素(TSH)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、TPOAb检测,并对检测结果进行统计学分析。
    结果 随着孕周的延长,Hb在妊娠中、晚期显著低于妊娠早期和对照组(F=68.25,P<0.001),RDW⁃SD和RDW⁃CV则显著升高(F=41.34,P<0.001;F=3.64,P=0.012)。Plt在整个妊娠期均显著低于对照组(F=43.21,P<0.001)。TSH在妊娠早、中期显著低于对照组(Z=53.49,P<0.001),但随孕周增加逐渐升高。TT3和TT4在整个妊娠期均显著高于对照组(F=148.25,P<0.001;F=210.83,P<0.001),而FT3和FT4在妊娠中、晚期显著低于妊娠早期和对照组(F=42.95,P<0.001;F=101.73,P<0.001)。TPOAb异常率在整个妊娠期均显著高于对照组(χ2=25.61,P<0.001)。TPOAb阳性组孕妇的TSH和RDW⁃CV显著高于TPOAb阴性组孕妇(Z=5.70,P<0.001;t=2.39,P=0.018)。
    结论 孕妇Hb、Plt、甲状腺激素水平与孕周存在密切的关系。随着孕周的增加,TPOAb异常率下降,但TPOAb阳性的孕妇TSH水平和RDW⁃CV更高,需要临床加强注意和筛查,从而提高母婴健康水平。

     

    Abstract:
    Objective To investigate the patterns of changes in routine blood parameters, thyroid hormone levels, and their correlations with thyroid peroxidase antibodies (TPOAb) among women at different stages of pregnancy, so as to provide a theoretical basis for maternal and child health care and diagnosis and treatment.
    Methods A total of 732 pregnant women at different stages of pregnancy who underwent health examinations at the First Maternity and Infant Hospital affiliated to Tongji University from May 2020 to August 2022 were selected as the observation group. The group comprised 245 women in the first trimester (≤12 weeks), 247 women in the second trimester (between13 and 27 weeks) and 240 women in the third trimester (≥28 weeks). Additionally, 240 non-pregnant, healthy women of child-bearing age who conducted their health checkups in the same hospital were selected as the control group. All the research subjects were required to provide peripheral venous blood samples to measure hemoglobin (Hb), standard deviation of red blood cell distribution width (RDW-SD), coefficient of variation of red blood cell distribution width (RDW-CV), platelet (Plt) count, platelet distribution width (PDW), as well as thyroid stimulating hormone (TSH), total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), and TPOAb. The results were statistically analyzed.
    Results With advancing gestational age, Hb levels were significantly lower in the second and third trimesters than in the first trimester and the control group (F=68.25, P<0.001), while RDW-SD and RDW-CV were significantly higher (F=41.34, P<0.001; F=3.64, P=0.012). Plt levels throughout pregnancy were significantly lower than that in the control group (F=43.21, P<0.001). TSH levels were significantly lower in the first and second trimesters than in the control group (Z=53.49, P<0.001), but gradually increased with gestational age. TT3 and TT4 levels were significantly higher than those in the control group throughout pregnancy (F=148.25, P<0.001; F=210.83, P<0.001), while FT3 and FT4 levels were significantly lower in the second and third trimesters than in the first trimester and the control group (F=42.95, P<0.001; F=101.73, P<0.001). The abnormal rate of TPOAb was significantly higher than that in the control group throughout pregnancy (χ2=25.61, P<0.001). Among pregnant women, those with TPOAb positivity had significantly higher TSH levels and RDW-CV than those with TPOAb negativity (Z=5.70, P<0.001; t=2.39, P=0.018).
    Conclusion The levels of Hb, Plt, and thyroid hormones in pregnant women are closely related to gestational age. With increasing gestational age, the abnormal rate of TPOAb decreases, but the TSH levels and RDW-CV of TPOAb positive pregnant women are higher, requiring clinical attention and screening to improve maternal and child health.

     

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