| Background and objective:Preeclampsia is a specific serious complication during pregnancy.It occurs after20 weeks of gestation,with an incidence of 2%-8%.That is,on the basis of elevated blood pressure,there are any organ or system involvement manifestations,whether proteinuria or not.It is one of the main reasons for the increase of maternal and perinatal mortality,which seriously threatens maternal and fetal safety.The pathogenesis of pre-eclampsia has not been fully elucidated,but studies have shown that its mechanism involves vascular endothelial dysfunction,over-activation of inflammation and immunity,genetic factors,endocrine and metabolic factors caused increased uterine artery blood flow resistance,inadequate placental perfusion,resulting in placental or trophoblast ischemia and hypoxia.At present,preeclampsia is usually divided into early onset preeclampsia and late onset preeclampsia,and it is believed that there may be different pathogenesis between them.Thyroid hormone is an essential endocrine hormone synthesized and secreted by follicular epithelial cells to promote normal growth and development,regulate energy metabolism and material metabolism.Thyroid hormones play an important role in the development of fetal and neonatal nervous system while maintaining the balance of maternal energy metabolism.In recent years,thyroid disorders in pregnancy are more and more common.Studies at home and abroad have shown that thyroid dysfunction in pregnancy may lead to abortion,premature delivery,preeclampsia,and even mental retardation of offspring.However,there are few reports on the relationship between early-onset preeclampsia,late-onset preeclampsia and thyroid dysfunction,and the maternal and infant outcomes of preeclampsia combined with thyroid dysfunction.In this study,early-onset preeclampsia and late-onset preeclampsia women were selected as the study subjects.Meanwhile,non-preeclampsia women delivered at the same time in our hospital were selected as the control group.Serum thyroid stimulating hormone,free thyroxine levels and thyroid peroxidase antibody titers were measured.To analyze the situation of thyroid dysfunction in each group,and to explore the influence of subclinical hypothyroidism and hypothyroidism on maternal and infant outcomes in patients with early-onset and late-onset preeclampsia,so as to provide reference for the prevention and treatment of preeclampsia with thyroid dysfunction in pregnancy.Materials and methods:1 Research objects and groupingA perinatal health manual was established in the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2018.205 cases of single-fetus early-onset preeclampsia and 205 cases of late-onset preeclampsia were selected as the study group.Another 205 cases of non-preeclampsia women who delivered in our hospital during the same period were selected as the control group.All subjects received regular maternity examination and routine perinatal insurance.The gestational age was more than 28 weeks and the age was 20-40 years old.This study was examined and approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University.All subjects followed the principle of voluntariness and signed the informed consent.2 Research MethodsThe general situation and clinical data of three groups of subjects were retrospectivelyanalyzed.All subjects were sampled non-anticoagulant 3mL from fasting vein in the morning of admission and serum was separated.Thyroid stimulating hormone,free thyroxine and thyroid peroxidase antibody titers in serum were determined by automated chemiluminescence immunoassay and diagnostic kit produced by Bayer Company in Germany.Coefficient of variation within and between batches was less than 4%.According to the TSH,FT4 levels and TPOAb titers measured,the thyroid function was evaluated,and the maternal complications and perinatal outcomes of early-onset and late-onset preeclampsia were counted.3 Statistical methodsIn this study,SPSS 21.0 software was used to process the normal distribution measurement data,which were expressed by(?x±s).Independent sample t test was used for comparison between the two groups.One-way ANOVA was used for comparison of the three groups and above,and SNK was used for comparison of the two groups.Median(M)and bilateral limit values(P 2.5-P 97.5)were used to measure the non-normal distribution data.Mann-Whitney U test was used for inter-group comparison and Kruskal-Wallis rank sum test was used for inter-group comparison.The counting data were expressed as%withχ~2 test and P<0.05 showed significant difference.Results:1.There was no significant difference in age,number of pregnancies,parity,BMI before pregnancy and weight gain during pregnancy among the three groups(P>0.05).2.There were significant differences in serum TSH and FT4 levels among the three groups(_?2=39.884、19.930,P<0.05).There was no significant difference in the positive rate of TPOAb among the three groups(_?2=0.094,P>0.05).The serum TSH levels in early onset group and late onset group were higher than those in control group(Z=-5.831、-4.674,P<0.05).The serum TSH level in early onset group was higher than that in late onset group(Z=-2.046,P<0.05).The serum FT4levels in early-onset group and late-onset group were lower than those in control group(Z=-2.732,-4.487,P<0.05).There was no significant difference in serum FT4level between early onset group and late onset group(Z=-1.514,P>0.05).3.There were significant differences in the incidence of total thyroid dysfunction,clinical hypothyroidism,subclinical hypothyroidism and hypothyroidemia among the three groups(_?2=36.260、11.091、24.135、12.342,P<0.05).There were no significant difference in the incidence of hyperthyroidism/subclinical hyperthyroidism and simple autoantibody among the three groups(_?2=0.503、3.570,P>0.05).The incidence of total thyroid disease and clinical hypothyroidism in the early onset group was higher than that in the control group(_?2=32.787、7.567,P<0.05).The incidence of total thyroid disease and clinical hypothyroidism in the late onset group was higher than that in the control group(_?2=22.797、11.695,P<0.05).There was no significant difference in the incidence of total thyroid disease,clinical hypothyroidism between early-onset group and late-onset group(_?2=0.708、0.977,P>0.05).The incidence of subclinical hypothyroidism in early onset group was higher than that in control group and late onset group(_?2=20.839、11.595,P<0.05).There was no significant difference in the incidence of subclinical hypothyroidism between late onset group and control group(_?2=1.481,P>0.05).The incidence of hypothyroidemia in the late-onset group was higher than that in the control group(_?2=12.261,P<0.05).There were no significant difference between the early-onset group and the late-onset group and the control group(_?2=2.811、3.595,P>0.05).4.The incidence of neonatal asphyxia and neonatal sepsis in the early-onset preeclampsia with subclinical hypothyroidism group was higher than that in the early-onset preeclampsia with normal thyroid function group(_?2=9.666、4.560,P<0.05).The gestational weeks of termination and birth weight of newborns in the group of early-onset preeclampsia with subclinical hypothyroidism were lower than those in the group of normal thyroid function of early-onset preeclampsia(t=3.893、3.551,P<0.05).The incidence of neonatal sepsis in early-onset preeclampsia with hypothyroidemia group was higher than that in early-onset preeclampsia with normal thyroid function group(_?2=12.649,P<0.05).5.The incidence of neonatal respiratory distress and neonatal sepsis in late-onset preeclampsia with subclinical hypothyroidism group was higher than that in late-onset preeclampsia with normal thyroid function group(_?2=4.405、5.628,P<0.05).In late-onset preeclampsia with subclinical hypothyroidism group,gestational weeks of termination and birth weight of newborns were lower than those in late-onset preeclampsia with normal thyroid function(t=2.407、4.211,P<0.05).The incidence of neonatal respiratory distress in late-onset group with hypothyroidemia was higher than that in late-onset group with normal thyroid function(_?2=4.615,P<0.05).Conclusions:1.The incidence of thyroid dysfunction in early-onset and late-onset preeclampsia was higher than that in non-preeclampsia women.2.Thyroid hormone deficiency in the third trimester of pregnancy aggravates the adverse pregnancy outcomes of preeclampsia patients,especially the adverse perinatal outcomes of offspring. |
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