妊娠期亚临床甲减胎儿结局影响因素的病例对照研究

doi:10.3760/cma.j.cn441417-20250115-16007

摘要/Abstract

摘要：

目的　基于病例对照研究分析妊娠期亚临床甲状腺功能减退（SCH）胎儿不良结局的影响因素，并构建风险预测模型。方法　采用回顾性分析，选取2021年9月至2024年9月于西北妇女儿童医院产检并分娩发生胎儿不良结局的71例妊娠期SCH患者临床资料，纳入研究组，另选取同期本院产检并分娩未发生胎儿不良结局的142例妊娠期SCH患者临床资料，纳入对照组。比较两组临床资料；将两组存在差异的临床资料纳入多因素logistic回归模型，分析妊娠期SCH胎儿不良结局的影响因素，构建风险预测模型；采用χ²检验、t检验、Mann-Whitney U检验进行统计比较，受试者操作特征曲线（ROC）评估风险预测模型的预测效能，校正曲线评估风险预测模型对胎儿结局的区分度。结果　研究组年龄大于对照组（P<0.05），妊娠前体重指数（BMI）、促甲状腺激素（TSH）、过氧化物酶抗体（TPOAb）水平及合并妊娠期贫血的构成比高于对照组（均P<0.05），血清叶酸水平低于对照组（P<0.05）。多因素logistic回归模型分析显示，年龄大（OR=2.959，95%CI 1.491～5.869）、妊娠前BMI高（OR=2.142，95%CI 1.201～3.823）、合并妊娠期贫血（OR=2.680，95%CI 1.202～5.976）、高水平TSH（OR=2.811，95%CI 1.355～5.831）、高水平TPOAb（OR=3.131，95%CI 1.554～6.308）是妊娠期SCH的危险因素（均P<0.05），叶酸水平高（OR=0.518，95%CI 0.338～0.792）是保护因素（均P<0.05）。构建风险预测模型，ROC显示，该模型预测SCH胎儿不良结局的曲线下面积（AUC）为0.918（95%CI 0.873～0.951，Z=19.742，P<0.001），灵敏度为95.77%，特异度为85.92%。Hosmer-Lemeshow检验显示，风险预测模型预测胎儿不良结局的预测概率与实际概率的校准曲线比较，差异无统计学意义（χ²=0.715，P=0.398）。结论　年龄大、妊娠前BMI高、合并妊娠期贫血、高水平TSH、高水平TPOAb是妊娠期SCH胎儿不良结局的危险因素，高水平叶酸是保护因素，纳入上述因素构建的风险预测模型经验证具有良好的临床效能，可为胎儿结局的预测提供量化方案。

关键词:

甲状腺功能减退症, 妊娠结局, 预测, 病例对照研究

Abstract:

Objective　To identify the risk factors of adverse fetal outcomes in pregnant women with subclinical hypothyroidism (SCH) through a case-control approach and to develop a predictive model for risk assessment. Methods　This was a retrospective study. Seventy-one pregnant women with SCH who experienced adverse fetal outcomes during antenatal care and delivery at Northwest Women's and Children's Hospital between September 2021 and September 2024 were selected as a study group. One hundred and forty-two pregnant women with SCH who did not experience adverse fetal outcomes during the same period were selected as a control group. The clinical data were compared between the two groups. The variables with statistical differences were analyzed using the multivariate logistic regression model to identify the independent risk factors of adverse fetal outcomes. χ², t, and Mann-Whitney U tests were used for the statistical comparisons. A predictive model was constructed and evaluated using receiver operating characteristic curves (ROC) for its performance; calibration curves were used to evaluate this model's discrimination. Results　The age, body mass index (BMI) before pregnancy, levels of thyrotropin (TSH) and thyroid peroxidase antibody (TPOAb), and the proportion of the women with gestational anemia in the study group were higher than those in the control group (all P<0.05), and the serum folate level was lower (P<0.05). The multivariate logistic regression model analysis indicated that elder age (OR=2.959, 95%CI 1.491-5.869), high pre-pregnancy BMI (OR=2.142, 95%CI 1.201-3.823), gestational anemia (OR=2.680, 95%CI 1.202-5.976), high TSH (OR=2.811, 95%CI 1.355-5.831), and high TPOAb (OR=3.131, 95%CI 1.554-6.308) were independent risk factors of SCH during pregnancy, while high folate (OR=0.518, 95%CI 0.338-0.792) was a protective factor (all P<0.05). A risk prediction model was constructed. The ROC showed that the area under the curve (AUC) of this model for adverse fetal outcomes of SCH was 0.918 (95%CI 0.873-0.951; Z=19.742; P<0.001), with a sensitivity of 95.77% and a specificity of 85.92%. The Hosmer-Lemeshow test showed that the predictive probability of adverse fetal outcomes by this model was not statistically different from the actual probability by the calibration curve (χ²=0.715; P=0.398). Conclusions　Elder age, high pre-pregnancy BMI, gestational anemia, high TSH, and high TPOAb are risk factors for adverse fetal outcomes in women with SCH, whereas folate serves as a protective factor. The predictive model constructed by the above factors has good clinical performance, and may provide a quantitative plan for predicting fetal outcomes.

Key words:

Hypothyroidism, Pregnancy outcomes, Prediction, Case-control study

王博王艳霞徐晓艳张明李欢.

妊娠期亚临床甲减胎儿结局影响因素的病例对照研究 [J]. 国际医药卫生导报, 2025, 31(16): 2673-2678.

Wang Bo, Wang Yanxia, Xu Xiaoyan, Zhang Ming, Li Huan.

A case-control study on influencing factors of fetal outcomes of subclinical hypothyroidism during pregnancy [J]. International Medicine and Health Guidance News, 2025, 31(16): 2673-2678.

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