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目的探讨超声联合羊水相关激素评价胎儿甲状腺功能的可行性。方法选取2012年1月~6月间在该院行羊膜腔穿刺术的孕18~41周正常孕妇160例分为正常组,检测羊水中三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、血清促甲状腺素(TSH)浓度并建立正常值。利用所得正常值对2013年2月~2014年2月间来该院产前检查的402例高危胎儿(异常组)进行超声筛查,存在甲状腺肿大时再行羊膜腔穿刺术,检测其羊水相关激素水平。结果孕18~41周,羊水T3、FT3水平逐渐提升,与孕周之间呈明显正相关(P<0.05);羊水T4、FT4、TSH水平在不同孕周内含量较为稳定,与孕周之间无明显相关性(P>0.05)。402例高危胎儿中有7例甲状腺肿大,根据Huel标准评分均<2分,说明胎儿甲状腺功能减退(甲减);将7例甲减胎儿分为甲减组,发现其羊水T3、FT3水平均明显低于正常值,TSH水平明显高于正常值,差异均有统计学意义(P<0.05);甲减组和正常组胎儿羊水T4水平之间差异无统计学意义(P>0.05)。结论超声联合羊水甲状腺相关激素测定可有效评价胎儿甲状腺功能,具有较高的临床应用价值。
Objective To investigate the feasibility of ultrasound combined with amniotic fluid hormone to evaluate fetal thyroid function. Methods One hundred and sixty normal pregnant women who underwent amniocentesis between January and June 2012 at 18 to 41 weeks of gestation were divided into normal group, triamcinolone acetonide (T3) and thyroxine T4 ), Free triiodothyronine (FT3), free thyroxine (FT4) and serum thyrotropin (TSH) were measured and normalized. Using the obtained normal values, 402 high-risk fetuses (abnormal group) for antenatal examination in the hospital from February 2013 to February 2014 were screened by ultrasound and amniocentesis was performed when the goiter was detected. The amniotic fluid Related hormone levels. Results The levels of T3 and FT3 in amniotic fluid gradually increased from 18 to 41 weeks of gestation, and positively correlated with gestational age (P <0.05). The contents of T4, FT4 and TSH in amniotic fluid were stable in different gestation weeks, There was no significant correlation (P> 0.05). Among the 402 high-risk fetuses, 7 had goiter. The scores of Hypothyroidism (hypothyroidism) were all less than 2 according to the Huel criteria. The 7 hypothyroidism children were divided into hypothyroidism group and found that the levels of amniotic fluid T3 and FT3 Were significantly lower than the normal value, TSH levels were significantly higher than the normal value, the difference was statistically significant (P <0.05); hypothyroidism and normal group of fetal amniotic fluid T4 levels between the difference was not statistically significant (P> 0.05). Conclusion Ultrasound combined with amniotic fluid thyroid hormone can effectively evaluate fetal thyroid function, which has high clinical value.