妊娠期（怀孕初期）甲状腺功能减退症筛查。
"Hypothyroidism screening during first trimester of pregnancy".
机构信息
Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Ctra. Nac. IV, km 665. Puerto Real, Cádiz, Spain.
Department of Clinical Analyses, University Hospital of Puerto Real, Crta Nac. IV, km 655. Puerto Real, Cádiz, Spain.
出版信息
BMC Pregnancy Childbirth. 2017 Dec 22;17(1):438. doi: 10.1186/s12884-017-1624-x.
BACKGROUND
Subclinical hypothyroidism is defined as an elevated thyroid-stimulating hormone level with a normal thyroxin level without signs or symptoms of hypothyroidism. Although it is well accepted that overt hypothyroidism has a deleterious impact on pregnancy, recent studies indicate that subclinical hypothyroidism may affect maternal and fetal health. Studies suggest an association between miscarriage and preterm delivery in euthyroid women positive for anti-peroxidase antibodies and/or anti-thyroglobulin antibodies. A proposal of a new set-point to diagnose SCH was recently published. The aim of this research was to determine the optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of our clinical area and to determine the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies.
METHODS
This cross-sectional study determines the cutoff point for SCH screening and evaluates its usefulness to detect TPO Ab using the Receiver Operating Characteristics (ROC) curve. Prevalence of SCH was calculated using as cut-off 2.5 mIU/L, 4 mIU/L, and our TSH 97.5th percentile. The ability to detect positive anti-thyroglobulin antibodies (TG Ab) and anti-thyroid peroxidase antibodies (TPO Ab) in patients with levels of TSH >97.5th percentile was determined by ROC curves.
RESULTS
The mean, range and standard deviation of TSH was 2.15 ± 1.34 mIU/L (range 0.03-8.82); FT4 was 1.18 ± 0.13 ng/dL (range 0.94-1.3); TG Ab was 89.87 ± 413.56 IU/mL (range 0.10-4000); and TPO Ab was 21.61 ± 46.27 IU/mL(range 0.10-412.4). The ROC. analysis of the ability of the TSH level to predict the presence of positive TPO Ab found an AUC of 0.563.
CONCLUSION
In our population, the TSH cutoff value for gestational SCH screening is 4.7 mIU/L. Using the SEGO recommended 2.5 mIU/L TSH cut-off point, the prevalence of SCH is 37%. Applying the ATA 2017 recommended cutoff point of 4 mIU/L, the prevalence of SCH is 9.6%. Finally, when the cut-off of 4.7 mIU/L (our 97.5th centile) was used, the SCH prevalence is 5%. TSH levels in the first trimester of pregnancy are not useful to detect TPO Ab.
背景
亚临床甲状腺功能减退症被定义为甲状腺刺激激素水平升高，甲状腺素水平正常，无甲状腺功能减退的体征或症状。尽管人们普遍认为显性甲状腺功能减退症对妊娠有不良影响，但最近的研究表明，亚临床甲状腺功能减退症可能会影响母婴健康。研究表明，在抗过氧化物酶抗体和/或抗甲状腺球蛋白抗体阳性的甲状腺功能正常的妇女中，流产和早产之间存在关联。最近发表了一项诊断亚临床甲状腺功能减退症的新切点建议。本研究旨在确定我们临床区域人群妊娠早期筛查亚临床甲状腺功能减退症的最佳促甲状腺激素截断值，并确定该筛查试验检测甲状腺过氧化物酶抗体的诊断价值。
方法
这项横断面研究确定了 SCH 筛查的截断值，并使用接受者操作特征（ROC）曲线评估了其检测甲状腺过氧化物酶抗体的有用性。使用 2.5 mIU/L、4 mIU/L 和我们的 TSH 97.5 百分位数作为切点来计算 SCH 的患病率。通过 ROC 曲线确定 TSH 水平 >97.5 百分位数的患者中检测阳性抗甲状腺球蛋白抗体（TGAb）和抗甲状腺过氧化物酶抗体（TPOAb）的能力。
结果
TSH 的平均值、范围和标准差为 2.15±1.34 mIU/L（范围 0.03-8.82）；FT4 为 1.18±0.13 ng/dL（范围 0.94-1.3）；TGAb 为 89.87±413.56 IU/mL（范围 0.10-4000）；TPOAb 为 21.61±46.27 IU/mL（范围 0.10-412.4）。TSH 水平预测 TPOAb 阳性存在的 ROC 分析发现 AUC 为 0.563。
结论
在我们的人群中，妊娠期 SCH 筛查的 TSH 截断值为 4.7 mIU/L。使用 SEGO 推荐的 2.5 mIU/L TSH 截断值，SCH 的患病率为 37%。应用 ATA 2017 推荐的 4 mIU/L 截断值，SCH 的患病率为 9.6%。最后，当使用 4.7 mIU/L（我们的 97.5 百分位数）作为截断值时，SCH 的患病率为 5%。妊娠早期 TSH 水平不能用于检测 TPOAb。
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