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投稿时间：2025-04-09 网络发布日期：2025-06-20
投稿时间：2025-04-09 网络发布日期：2025-06-20
中文摘要: 目的 评估孕妇妊娠早期甲状腺激素水平与妊娠期高血压疾病（HDP）的相关性，为临床预防HDP的发生提供参考。方法 回顾性纳入2020年 6 月 至 2023年 2月在首都医科大学附属北京妇产医院建档并规律产检至分娩的单胎妊娠孕妇2 602名，孕早期均测量血清促甲状腺激素（TSH）、游离甲状腺素T4（FT4）和甲状腺过氧化物酶抗体（TPOAb），收集孕妇的相关临床资料、妊娠期并发症以及相关妊娠结局，分析孕早期TSH水平与HDP发病的关联。结果 2 602名妊娠妇女中，有196名孕妇发展为HDP（发病率为7.53%）。与非HDP组比较，HDP组孕妇的年龄和身体质量指数（BMI）高、辅助生殖受孕（ART）占比高、分娩孕周及其新生儿出生体重偏低、剖宫产占比高、孕早期的TSH水平较高（P<0.05），但两组的FT4水平及TPO阳性率差异无统计学意义（P>0.05）。将孕早期TSH水平按照五分位数分组（Q1：0.01~0.60 mIU/L，Q2：0.61~1.11 mIU/L，Q3：1.12~1.63 mIU/L，Q4：1.64~2.43 mIU/L，Q5：2.44~37.44 mIU/L），结果显示，与 Q1 组相比，Q4 组（OR = 1.885，95% CI：1.176~3.020，P=0.008）和 Q5 组（OR=1.755，95% CI: 1.088~2.830，P= 0.021）孕妇发生HDP的风险显著增加。且在控制孕妇的年龄、BMI、ART、FT4水平及孕期甲状腺素药物治疗等潜在混杂因素后，Q4组（调整后OR = 1.856，95% CI：1.108~3.109，P=0.019）和Q5组（调整后OR = 1.910，95% CI ：1.106~3.300，P=0.020）孕妇发生HDP的风险依然显著增加。结论 孕妇妊娠早期TSH水平> 1.63 mIU/L是发生HDP的独立危险因素，临床对于高TSH水平的孕妇应注意及时关注其血压。
Abstract:Objective To evaluate the relationship between thyroid hormone levels in early pregnancy and hypertensive disorders of pregnancy（HDP），and to provide a reference for clinical prevention of HDP. Methods A total of 2 602singleton pregnant women who were registered and received regular prenatal examinations until delivery at Beijing Obstetrics and Gynecology Hospital，Capital Medical University from June 2020 to February 2023 were retrospectively included. Serum thyroid ? stimulating hormone （TSH），free thyroxine T4（FT4）and thyroid peroxidase antibody（TPOAb）were measured in early pregnancy. Their clinical data，pregnancy complications and relevant pregnancy outcomes were collected，and the association between TSH levels in early pregnancy and the incidence of HDP was analyzed. Results Among the 2 602 pregnant women，196 developed HDP（incidence rate of 7.53%）. Compared with the non ? HDP group，the HDP group had higher age and body mass index（BMI），higher proportion of assisted reproductive technology（ART）conception，lower gestational weeks at delivery and neonatal birth weight，higher proportion of cesarean section，and higher TSH levels in early pregnancy（P < 0.05）. However，there were no statistically significant difference in FT4 levels and TPOAb positive rate between the two groups（P > 0.05）. The TSH levels in early pregnancy were grouped by quintiles（Q1：0.01-0.60 mIU/L，Q2：0.61-1.11 mIU/L，Q3：1.12-1.63 mIU/L，Q4：1.64-2.43 mIU/L，Q5：2.44-37.44 mIU/L）. The results showed that compared with the Q1 group，the risks of HDP in the Q4group（OR=1.885，95%CI：1.176-3.020，P= 0.008）and the Q5 group（OR=1.755，95%CI：1.088-2.830，P= 0.021）were significantly increased. After controlling potential confounding factors such as the pregnant women’s ages，BMI，ART，FT4 levels and thyroid hormone drug treatment during pregnancy，the risks of HDP in the Q4 group（adjusted OR = 1.856，95%CI：1.108-3.109，P = 0.019）and the Q5 group（adjusted OR=1.910，95%CI：1.106-3.300，P=0.020） were still significantly increased. Conclusion TSH level during early pregnancy > 1.63 mIU/L is an independent risk factor for HDP. Clinicians should pay attention to monitoring blood pressure in pregnant women with high TSH levels.
keywords: Hypertensive disorders of pregnancy Thyroid hormone Pregnant woman Pregnant complication Early pregnancy
文章编号： 中图分类号：R459.5 文献标志码：A
基金项目:北京市医院管理中心局人才培养计划青苗项目（QMS20191402）
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引用文本：
赵蓉， 张同庆， 张亚伟， 郑媛媛， 姜海利.孕早期甲状腺激素水平与妊娠期高血压疾病的相关性[J].中国临床研究,2025,38(6):910-913，918.
赵蓉， 张同庆， 张亚伟， 郑媛媛， 姜海利.孕早期甲状腺激素水平与妊娠期高血压疾病的相关性[J].中国临床研究,2025,38(6):910-913，918.