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早孕时期hCG检测助于子痫前期风险预测

2016-06-08 犀牛 医学界

那些怀孕与甲状腺功能间牵扯不清的事众所周知,判断女性是否怀孕可以通过血hCG(人绒毛促性腺激素)检查来确定。hCG是在女性妊娠后自然升高的一种胎盘类激素,由于hCG分子跟TSH(促甲状腺激素)分子结构具有相似性,早在上世纪70年代就有实验证明hCG对甲状腺具有刺激作用。因此,在早孕时期由于hCG的快速增长,会导致血清甲状腺激素的升高,而TSH则会受到抑制。当然,滋养细胞疾病也会导致hCG分泌的大量

那些怀孕与甲状腺功能间牵扯不清的事

众所周知,判断女性是否怀孕可以通过血hCG(人绒毛促性腺激素)检查来确定。hCG是在女性妊娠后自然升高的一种胎盘类激素,由于hCG分子跟TSH(促甲状腺激素)分子结构具有相似性,早在上世纪70年代就有实验证明hCG对甲状腺具有刺激作用。因此,在早孕时期由于hCG的快速增长,会导致血清甲状腺激素的升高,而TSH则会受到抑制。当然,滋养细胞疾病也会导致hCG分泌的大量增加,但今日姑且不论。

测hCG可预测出现子痫前期风险?

2016年欧洲内分泌协会大会发布的一则最新消息:早孕时期监测hCG值能够帮助预测甲状腺功能在正常高限水平的孕妇出现子痫前期的风险。如果是由于怀孕hCG升高导致生理性甲状腺功能的增高,孕妇患子痫前期的风险还不那么足以为惧,而那些hCG偏低而甲状腺功能仍然偏高的孕妇们或许就该医生们担心了。

该消息来源于一个针对5803名孕妇在早孕时期(18周及以前)所进行的实验,测试内容包括TSH、游离甲状腺素和hCG水平,将子痫前期作为结果纳入统计。

早先就已经有研究表明早孕时期游离甲状腺素偏高会造成出现子痫前期的风险增加,但该实验没有明确低TSH与子痫前期风险之间的关系。

而近来的研究表明,那些游离甲状腺素偏高伴有低hCG水平(<35000mIU/ml)的孕妇出现子痫前期的风险是那些游离甲状腺素位于中等水平的孕妇风险的4倍。而FT4位于临界高值与hCG>20.0这两个条件同时存在时,出现子痫前期的风险并不会增加。上文已经分析过了孕妇的TSH往往会较未妊娠时要低,但如果TSH的水平被压制得太低(<0.1mIU/ml)的话,出现子痫前期的风险也会增加,但是就出现子痫前期的风险而言,低TSH水平的影响就较高游离甲状腺素的影响要小得多了。

实验同时发现,接近1/3的孕妇早孕时期hCG是低于35000mIU/ml的,因此,测hCG值有1/3的机会能够帮助鉴别游离甲状腺素偏高的原因,预测出现子痫前期的风险。因为妊娠第10-17周对hCG的测量有非常高的易变性,因此重复测量是很有必要的,其中双胎较单胎更需要我们注意hCG波动的情况。

子痫前期是一种多因素造成的疾病状况

上述实验将很多因素纳入考虑,如母亲的年龄、妊娠年龄、是否吸烟、教育水平、种族特点、生产情况、BMI以及孩子的性别等等,其中很有意思的是,尽管肥胖的孕妇出现子痫前期的风险相对较高,其风险甚至较低hCG来得更高,由于其与低甲状腺素及低hCG相关,对于甲状腺功能亢进的人来说却可能存在一定的保护作用。而孕妇是否为初产妇则对于子痫前期的风险影响不大。另外TSH没有与其他风险因素具有协同作用。不管怎么样,这个实验都提示了子痫前期是一个多因素造成的疾病状况,而其中高甲状腺素是其中一个不可忽视的危险因素。

展望未来

由于子痫前期是一个多因素作用后的结果,无可否认,要相对准确地预计其风险性并不容易。现有的一些算法来预测子痫前期的风险准确性基本上能达到90%以上,但我们也期望通过纳入更多的风险因素以提高预测的准确性。

尽管子痫前期高血压、蛋白尿等症状是在妊娠20周以后才出现的,但是由于早孕时期是胎盘发育的重要阶段也是多种危险因素作用的主要阶段,子痫前期作为一种胎盘机能障碍导致的疾病,监测早孕时期的各项指标的变化可谓意义重大,如上文所述的体重指标、TSH、游离甲状腺素、hCG等等,还有促TSH受体抗体的检测等,妊娠中期的s-Flt1这个的监测,都有利于筛选出高风险的孕妇。因hCG升高导致的短暂性生理性甲状腺功能增高是不需要处理的,而如果功能增高时间过长或者是甲状腺功能亢进明显等一些病理性的情况,就需要医生及时地作出处理了。

上医治未病,把风险扼杀在摇篮里,距此我们还有很长的一段路要走。

参考文章:

1.http://www.medscape.com/viewarticle/864003

2.《hCG相关性甲状腺功能亢进_陈道雄》

3.《孕早期预测子痫前期_胎儿生长受限相关因素研究_钟艳》

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    2016-06-10 Arthur M

    早些

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=89280, encodeId=804f892804e, content=早些, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Fri Jun 10 23:28:00 CST 2016, time=2016-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=89185, encodeId=f5aa891856d, content=真的有用吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=191, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Fri Jun 10 08:13:00 CST 2016, time=2016-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366543, encodeId=ed541366543cb, content=<a href='/topic/show?id=097a452219b' target=_blank style='color:#2F92EE;'>#子痫前期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45221, encryptionId=097a452219b, topicName=子痫前期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52c7237, createdName=yahu, createdTime=Fri Jun 10 04:12:00 CST 2016, time=2016-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1414655, encodeId=915b141465530, content=<a href='/topic/show?id=04f98552df' target=_blank style='color:#2F92EE;'>#hCG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8552, encryptionId=04f98552df, topicName=hCG)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ec053077747, createdName=zgwhgch, createdTime=Fri Jun 10 04:12:00 CST 2016, time=2016-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485916, encodeId=032b148591629, content=<a href='/topic/show?id=2c62100911a3' target=_blank style='color:#2F92EE;'>#风险预测#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100911, encryptionId=2c62100911a3, topicName=风险预测)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e31a8064712, createdName=12498ebem21暂无昵称, createdTime=Fri Jun 10 04:12:00 CST 2016, time=2016-06-10, status=1, ipAttribution=)]
    2016-06-10 老段

    真的有用吗

    0

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    2016-06-10 yahu
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    2016-06-10 zgwhgch
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处于子痫前期的孕妇其体内可溶性Fms样酪氨酸激酶-1(sFlt-1)与胎盘生长因子(PIGF)的比值可在孕妇出现临床症状之前升高,但是这个比值对于预测疑似子痫前期孕妇是否处于子痫前期的价值尚未可知。

J Matern Fetal Neo Med:用一氧化氮供体对高危青年初孕妇出现的子痫前期进行预防性治疗:一项试点研究

目的: 子痫前期与发病率和死亡率显著相关,尤其是高危人群。内源性一氧化氮障碍已被证明是与该疾病相关,且预防性治疗可能改善这种状况,并改善妊娠结局。本研究评估一氧化氮供体对于高危青年初孕妇子痫前期的预防性治疗。方法:这项研究包括三百名小于20岁且单例妊娠的初产妇。怀孕24周时做腹部彩色多普勒超声脉冲,显示妊娠子宫动脉舒张期切口的孕妇被随机分配成一个控制组——接受安慰剂的阴道药片和一个实验组——异山梨

AJOG:神药二甲双胍或可用于子痫前期的治疗!

发表在AJOG的新研究表明,孕妇使用糖尿病治疗药物二甲双胍是安全的,且含有潜在的预防或治疗子痫前期的作用。AJOG的总编辑呼吁未来进行二甲双胍治疗子痫前期或其他妊娠并发症的相关临床试验。子痫前期指妊娠20周后出现血压增高、蛋白尿等。当胎盘血液供应不足时会释放物质促进母体血管收缩,导致血压增高,以及脑、肝、肾等脏器的损伤。孕妇中子痫前期发病率约5%-8%,是导致孕妇死亡的主要原因,全球范围内,每天有

BMJ:孕28周后血压监测可改善子痫前期预测模型

孕20-36周常规产前监测血压能否预测子痫前期和其相关的不良结局?研究者进行了一项,使用了12 996名女性的产前血压数据,开发预测模型,并对3005名女性进行该模型的验证。基于女性早孕期特征(BMI、身高、体重、年龄、产次、吸烟史、既然或现在有无妊娠期高血压疾病或妊娠期糖尿病、种族)和初始平均动脉压的模型与其他模型比较。研究结果显示,另外加入从28周开始的血压监测可以改善只是用孕早期危险因素的模

孕妇吃巧克力对胎儿生长发育有好处

在告知孕妇禁忌的食物清单之后,这项研究结果可能会被准妈妈们欢欣鼓舞。 虽然巧克力本身并不属于食物禁忌,但是有研究指出准妈妈们应鉴于巧克力中的脂肪、糖和咖啡因含量而限制摄入。巧克力中含有黄烷醇,可降低民众心血管疾病的风险,并降低其胆固醇水平。黑巧克力中含有更多的黄烷醇。 既往研究表明,孕期吃适量的巧克力可以会降低产妇患子痫前期的风险。魁北克拉瓦尔大学Emmanuel Bujold博士指出孕期摄入巧克

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