基于不同参考标准评估双胎妊娠孕早期甲状腺功能异常对妊娠结局的影响研究
Impact of Thyroid Dysfunction in Twin Pregnancies during the First Trimester on Pregnancy Outcomes：a Comparative Study Based on Different Reference Standards
陈腾达 1张黎锐 1严欣 1郑薇 1李光辉 1袁仙仙1
作者信息
- 1. 100026 北京市，首都医科大学附属北京妇产医院 北京妇幼保健院营养与内分泌代谢科
- 折叠
摘要
背景 甲状腺激素对机体新陈代谢、生长发育至关重要，尤其在孕早期对胎儿发育有关键作用。目前关于双胎妊娠甲状腺激素参考范围的研究尚不统一，大多数关于双胎妊娠甲状腺功能（简称甲功）异常与妊娠结局的研究仍以单胎妊娠的参考范围作为基准。目的 建立双胎妊娠女性孕早期促甲状腺激素（TSH）及游离甲状腺素（FT4）参考区间，比较基于单胎标准与双胎标准诊断的甲功异常发生率的差异，并比较两组标准下不同甲功状态的妊娠结局。方法 纳入2015年10月—2021年2月就诊首都医科大学附属北京妇产医院且符合纳入与排除标准的双胎孕妇，采用化学发光法检测孕早期TSH和FT4，按双侧限制P2.5~P97.5 确定参考区间。分别参考本院单胎妊娠孕早期甲功参考区间（TSH为0.59~3.54mIU/L，FT4 为11.8~18.4pmol/L）和本研究建立的双胎妊娠孕早期甲功参考区间为标准对双胎妊娠孕早期甲功结果进行分类，包括正常、亚临床甲状腺功能减退症（简称亚临床甲减）、临床甲状腺功能减退症（简称临床甲减）、亚临床甲状腺功能亢进（简称亚临床甲亢）和临床甲状腺功能亢进（简称临床甲亢），分析使用不同参考标准诊断的甲功异常的妊娠结局的差异。结果 本研究共纳入1 724例双胎妊娠孕妇，其中254例符合建立双胎妊娠孕早期甲功参考区间的纳排标准。本研究建立的双胎妊娠孕早期甲功参考区间为：TSH为0.11~3.16mIU/L，FT4 为2.45~28.56 pmol/L。使用单胎参考标准进行分类，诊断临床甲减2例（0.1%）、亚临床甲减33例（1.9%）、正常860例（49.9%）、亚临床甲亢363例（21.1%）、临床甲亢366例（21.2%）、其他100例（5.8%）。使用双胎参考标准进行分类，诊断临床甲减3例（0.2%）、亚临床甲减47例（2.7%）、正常1 609例（93.3%）、亚临床甲亢3例（0.2%）、临床甲亢3例（0.2%）、其他59例（3.4%）。使用单胎和双胎不同的孕早期甲功参考标准对双胎妊娠孕早期甲功进行分类，差异有统计学意义（P<0.001）。在甲功正常的孕妇中，单胎参考标准孕前BMI、孕早期TSH高于双胎参考标准，孕早期FT4 低于双胎参考标准（P<0.05）；在甲减的孕妇中，单胎参考标准孕早期TSH高于双胎参考标准（P<0.05）；在甲亢的孕妇中，单胎参考标准孕早期TSH、妊娠期总增重、新生儿出生体质量高于双胎参考标准，孕早期FT4 低于双胎参考标准（P<0.05）。回归分析结果显示，在甲亢的孕妇中，甲功参考标准不同与妊娠期增重和新生儿出生体质量相关（P<0.05）。结论 本中心双胎妊娠孕早期TSH参考范围为0.11~3.16 mIU/L，FT4 参考范围为2.45~28.56 pmol/L，使用双胎参考标准诊断的亚临床甲亢和甲亢例数少于单胎参考标准。在甲亢的孕妇中，甲功参考标准不同与妊娠期增重和新生儿出生体质量有关。
Abstract
Background Thyroid hormones are crucial for metabolismgrowthand development in the human bodyespecially playing a pivotal role in fetal development during early pregnancy. Currentlyresearch on thyroid hormone reference ranges for twin pregnancies remains inconsistentand most studies on thyroid dysfunction and pregnancy outcomes in twin pregnancies still use singleton pregnancy reference ranges as a benchmark. Objective To establish reference intervals for thyroid stimulating hormoneTSHand free thyroxineFT4in early pregnancy among women with twin pregnanciescompare the incidence of thyroid dysfunction diagnosed based on singleton versus twin standardsand compare pregnancy outcomes for different thyroid function statuses under the two standards. Methods Twin pregnant women who visited Beijing Obstetrics and Gynecology HospitalCapital Medical Universityfrom October 2015 to February 2021 and met the inclusion and exclusion criteria were enrolled. We used chemiluminescence to detect TSH and FT4 in early pregnancyand determined the reference range based on bilateral limits of P2.5-P97.5. The reference interval for thyroid function in the first trimester of single pregnancy in our hospital is TSH 0.59-3.54 mIU/L and FT4 11.8-18.4 pmol/Lrespectively. Thyroid function results in early pregnancy for twin pregnancies were classified using both singleton and twin reference standardsincluding normal thyroid functionsubclinical hypothyroidismhypothyroidismsubclinical hyperthyroidismand hyperthyroidism. Differences in pregnancy outcomes for thyroid dysfunction diagnosed using different reference standards were analyzed. Results A total of 1 724 twin pregnant women were enrolledof which 254 met the inclusion and exclusion criteria for establishing reference intervals for thyroid function in early twin pregnancies. The TSH range for twin pregnancies in early pregnancy was 0.11-3.16 mIU/Land the FT4 range was 2.45-28.56 pmol/L. Using the single reference standard for classification2 cases0.1%of clinical hypothyroidism were diagnosed33 cases1.9%of subclinical hypothyroidism860 cases49.9%of normal363 cases21.1%of subclinical hyperthyroidism366 cases21.2%of clinical hyperthyroidismand 100 cases5.8%of other. Using the twin reference standard for classification3 cases0.2%of clinical hypothyroidism were diagnosed47 cases2.7%of subclinical hypothyroidism1 609 cases93.3%of normal3 cases0.2%of subclinical hyperthyroidism3 cases0.2%of clinical hyperthyroidismand 59 cases3.4%of other. Using different reference standards for thyroid function in the first trimester of pregnancy for singleton and twin pregnanciesthere was a statistically significant difference in the classification of thyroid function in the first trimester of twin pregnancyP<0.001. Among pregnant women with normal thyroid functionthe pre-pregnancy BMI and early pregnancy TSH in the singleton reference standard were higher than those in the twin reference standardwhile the early pregnancy FT4 was lower than that in the twin reference standardP<0.05. Among pregnant women with hypothyroidismthe early pregnancy TSH in the singleton reference standard was higher than that in the twin reference standardP<0.05. Among pregnant women with hyperthyroidismthe early pregnancy TSHtotal weight gain during pregnancyand neonatal birth weight in the singleton reference standard were higher than those in the twin reference standardwhile the early pregnancy FT4 was lower than that in the twin reference standardP<0.05. The results of regression analysis showed that among pregnant women with hyperthyroidismdifferent reference standards for thyroid function were associated with gestational weight gain and neonatal birth weightP<0.05. Conclusion The TSH reference range for early twin pregnancies at our center is 0.11-3.16 mIU/Land the FT4 reference range is 2.45-28.56 pmol/L. The number of cases of subclinical hyperthyroidism and hyperthyroidism diagnosed using the twin reference standard is significantly lower than that using the single reference standard. In pregnant women with hyperthyroidismthe reference standards for thyroid function are related to weight gain during pregnancy and the birth weight of the newborn.关键词
双胎妊娠/甲状腺功能/参考标准/妊娠结局引用本文复制引用
陈腾达,张黎锐,严欣,郑薇,李光辉,袁仙仙.基于不同参考标准评估双胎妊娠孕早期甲状腺功能异常对妊娠结局的影响研究[EB/OL].(2026-02-25)[2026-03-01].https://chinaxiv.org/abs/202602.00222.学科分类
妇产科学
评论