河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (6): 660-665,680.doi: 10.3969/j.issn.1007-3205.2023.06.008

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甲状腺功能检测与监测血压变异系数对预测妊娠期甲状腺功能减退患者妊娠结局的临床价值

  

  1. 河北省张家口市第一医院内分泌科，河北 张家口 075000
  • 出版日期:2023-06-25 发布日期:2023-06-29
  • 作者简介:樊成芳（1988-），女，河北井陉人，河北省张家口市第一医院主治医师，医学学士，从事内分泌疾病诊治研究。
  • 基金资助:
    河北省医学科学研究课题计划（20211120）

Clinical value of thyroid function testing and monitoring blood pressure coefficient of variation in predicting pregnancy outcomes in patients with hypothyroidism during pregnancy

  1. Department of Endocrinology, the First Hospital of Zhangjiakou City, Hebei Province, Zhangjiakou 075000, China

  • Online:2023-06-25 Published:2023-06-29

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摘要： 目的 探讨甲状腺功能检测与监测血压变异系数对预测妊娠期甲状腺功能减退患者妊娠结局的临床价值。
方法 选取妊娠期甲状腺功能减退患者138例为观察组，其中临床甲状腺功能减退47例为观察1组，亚临床甲状腺功能减退91例为观察2组，同期选取入院孕检且甲状腺功能正常者48例为对照组。比较3组一般资料、甲状腺功能［促甲状腺激素（thyroid stimulating hormone，TSH）、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、游离甲状腺素（free thyroxine，FT4）］、血压［舒张压（diastolic blood pressure，DBP）、收缩压（systolic blood pressure，SBP）、舒张压变异系数（DBP coefficient of variation，DCV）、收缩压变异系数（SBP coefficient of variation，SCV）、舒张压标准差（DBP standard deviation，DSD）、收缩压标准差（SBP standard deviation，SSD）］，分析妊娠期甲状腺功能减退患者甲状腺功能与血压、血压变异性相关性，Logistic回归分析妊娠期甲状腺功能减退发生不良妊娠结局的影响因素，受试者工作特征（receiver operating characteristic，ROC）分析甲状腺功能、血压及血压变异性对不良妊娠结局的预测价值。
结果 3组妊娠期高血压比例及TSH、FT3、FT4、24 h-DBP、24 h-SBP、24 h-DCV、24 h-SCV、24 h-DSD、24 h-SSD比较，差异有统计学意义（P＜0.05）；妊娠期甲状腺功能减退患者甲状腺功能与血压、血压变异性有关（P＜0.05）；Logistic回归分析显示，TSH、24 h-DBP、24 h-SBP、24 h-DCV、24 h-SCV、24 h-DSD、24 h-SSD升高及FT3、FT4降低均为妊娠期甲状腺功能减退患者发生不良妊娠结局的独立危险因素（P＜0.05）；ROC曲线显示，TSH、FT3、FT4、24 h-DBP、24 h-SBP、24 h-DCV、24 h-SCV、24 h-DSD、24 h-SSD联合预测妊娠期甲状腺功能减退患者发生不良妊娠结局的曲线下面积(area under curve，AUC)值为0.962，高于单独预测。
结论 妊娠期甲状腺功能减退患者血压及血压变异系数较高，甲状腺功能检测联合血压变异系数可更有效预测妊娠结局，为及时干预治疗提供参考。


关键词: 妊娠, 甲状腺功能减退症, 血压变异系数

Abstract: Objective To investigate the clinical value of thyroid function testing and monitoring blood pressure coefficient of variation in predicting pregnancy outcomes in patients with hypothyroidism during pregnancy. 
Methods A total of 138 patients with hypothyroidism during pregnancy were selected as the observation group, including 47 cases of clinical hypothyroidism as the observation group one, and 91 cases of subclinical hypothyroidism as the observation group two. Forty-eight patients with normal thyroid function undergoing pregnancy tests were selected as the control group. The general data, thyroid function ［thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4)］, and blood pressure ［diastolic blood pressure (DBP), systolic blood pressure (SBP), DBP coefficient of variation (DCV), SBP coefficient of variation (SCV), DBP standard deviation (DSD), SBP standard deviation (SSD)］ were compared among three groups. The correlation between thyroid function, blood pressure and blood pressure variability in patients with hypothyroidism during pregnancy was analyzed. Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in hypothyroidism during pregnancy, and receiver operating characteristic (ROC) was used to analyze the predictive value of thyroid function, blood pressure and blood pressure variability for adverse pregnancy outcomes. 
Results The proportion of gestational hypertension and TSH, FT3, FT4, 24 h-DBP, 24 h-SBP, 24 h-DCV, 24 h-SCV, 24 h-DSD and 24 h-SSD among the three groups were significantly different (P<0.05); Thyroid function in patients with hypothyroidism during pregnancy was related to blood pressure and blood pressure variability (P＜0.05). Logistic regression analysis showed that increased TSH, 24 h-DBP, 24 h-SBP, 24 h-DCV, 24 h-SCV, 24 h-DSD, 24 h-SSD, and decreased FT3 and FT4 were independent risk factors for adverse pregnancy outcomes in patients with hypothyroidism during pregnancy (P＜0.05). The ROC curve showed that the area under the ROC curve (AUC) of TSH, FT3, FT4, 24 h-DBP, 24 h-SBP, 24 h-DCV, 24 h-SCV, 24 h-DSD, and 24 h-SSD in combination for predicting the adverse pregnancy outcome of patients with hypothyroidism during pregnancy was 0.962, which was higher than prediction of each index alone. 
Conclusion The blood pressure and blood pressure coefficient of variation are higher in patients with hypothyroidism during pregnancy. Thyroid function testing combined with blood pressure coefficient of variation can more effectively predict pregnancy outcome, and provide a reference for timely intervention and treatment. 

Key words: pregnancy, hypothyroidism during pregnancy, blood pressure coefficient of variation

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