摘要
目的探讨Graves’病患者在妊娠期间TRAb值的动态变化对子代甲状腺功能的影响,并构建子代发生甲状腺功能亢进的预测模型。方法63名患有Graves’病的患者在妊娠期间动态监测TRAb,根据孕晚期TRAb结果分为TRAb阳性组(n=27)和TRAb阴性组(n=36),另外随机选择正常孕产妇作为对照组(n=30),监测三组孕产妇分娩新生儿的临床特征、TRAb、FT4、TSH、超声心动图、甲状腺彩超等,并构建Graves’病患者子代发生甲状腺功能亢进的预测模型。结果TRAb阳性组新生儿中有16例(59.3%)TRAb阳性,4例(14.8%)确诊为甲状腺功能亢进症;TRAb阴性组新生儿中有2例(5.6%)TRAb阳性,TRAb阴性组及对照组均未发现新生儿甲状腺功能亢进症。多重线性回归分析显示孕晚期母体TRAb是发生新生儿甲状腺功能亢进的独立高危因素,阈值为13.75 IU/L,受试者操作曲线(ROC)曲线下面积是0.989,其敏感性为100%,特异性为95.65%。采用简单线性回归模型分析出孕早期TRAb阈值为22.97 IU/L。结论构建预测模型能有效预测Graves’病患者子代甲状腺功能亢进发生风险,有利于新生儿甲状腺功能亢进症的高效筛查和诊断。
Objective To investigate the effect of dynamic changes in TRAb values during pregnancy in patients with Graves’disease on thyroid function in their offspring,and to construct a predictive model for the development of hyperthyroidism in the offspring.Methods The TRAb values was dynamically monitored during pregnancy in 63 patients with Graves’disease.According to the results of TRAb values in the third trimester of pregnancy,they were divided into TRAb-positive group(n=27)and TRAb-negative group(n=36).In addition,normal pregnant women were randomly selected as the control group(n=30).The clinical characteristics,TRAb,FT4,TSH,echocardiography and thyroid color Doppler ultrasound of newborns delivered by pregnant women in the three groups were monitored,and the prediction model of hyperthyroidism in the offspring of patients with Graves’disease was constructed.Results In TRAb-positive group,16 cases(59.3%)of the newborns were TRAb positive,and 4 cases(14.8%)were diagnosed as neonatal hyperthyroidism.There were 2 cases(5.6%)of TRAb positive newborns in TRAb-negative group.No neonatal hyperthyroidism was found in either TRAb-negative group or control group.Multivariate analysis revealed that the TRAb values in the third trimester were independent risk factor for neonatal hyperthyroidism.The ROC curve analysis showed that the cut-off TRAb value in the third trimester for predicting neonatal hyperthyroidism was 13.75 IU/L.The area under the ROC curve was 0.989,with a sensitivity of 100% and specificity of 95.65%.The cut-off TRAb value in the first trimester was 22.97 IU/L by simple linear regression model.Conclusion The construction of prediction model can effectively predict the risk of hyperthyroidism in the offspring of patients with Graves’disease,which is conducive to the efficient screening and diagnosis of neonatal hyperthyroidism.
作者
周玲
陈泓锦
潘晓蕾
陈志超
ZHOU Ling;CHEN Hongjin;PAN Xiaolei;CHEN Zhichao(Department of Internal Medicine,Huizhou Second Maternal and Child Healthcare Hospital,Huizhou,Guangdong 516000,China;Department of Obstetrics,Huizhou Second Maternal and Child Healthcare Hospital,Huizhou,Guangdong 516000,China)
出处
《中国优生与遗传杂志》
2023年第3期513-517,共5页
Chinese Journal of Birth Health & Heredity
基金
惠州市科技计划项目(2021WC0106090)。