1-.妊娠甲状腺疾病指南（手册）.ppt

四、低甲状腺素血症（Hypothyroxinemia） 4-2 单纯性低甲状腺素血症增加不良妊娠结局和后代神经智力发育损害的证据不足，所以不推荐给予治疗。 C 推荐条款 低T4血症：调查 妊娠期母亲单纯低甲状腺素血症 FT4＜10.4~12 低T4血症：调查 FT4＜10.7 低T4血症：调查 HenrichsJ：JCEM 2010， 95：4227-4234 Nonverbal : 非言语；cognitive : 认知 非言语认知能力迟滞是对照组的1～2倍 低T4血症：调查 Pop VJ：Clin Endocrinol （Oxf）2003，59：282-288 Mental : 智力；motor : 运动 与正常对照，甲减者智力和运动能力随时间↓ * # Compared to control group* p=0.004；# p=0.007 分 组 No. PDI X±SD MDI X±SD 低T4血症 19 112.32±15.10* 112.21±12.26# 正常对照组 38 121.61±7.94 119.78±7.76 Li YB ,Shan ZY：Clin Endocrino;(oxf), 2010. 72(6):825-829. 低T4血症：调查 妊娠16-20周孕妇单纯低T4血症与后代PDI和MDI (智力发育指数) (精神运动发育指数) ↓ ↓ 五、妊娠甲状腺抗体阳性 Figure?1.?The TAZ10 transgenic mouse model10 and the immunological basis for Hashimoto thyroiditis.(a) Thyroid follicle and the location of the major thyroid autoantigens: thyroid peroxidase (TPO), thyroglobulin (Tg) and the thyroid-stimulating hormone receptor (TSHR). (b) Immunological mechanisms leading to the spectrum of human autoimmunity with differing pathological and clinical characteristics. Graves hyperthyroidism is caused directly by TSHR autoantibodies that activate the TSHR. Hypothyroidism in Hashimoto thyroiditis is associated with autoantibodies to TPO (and less commonly to Tg), but the relative contributions to thyrocyte damage by autoantibodies, TPO-specific T cells and/or cytokines is unknown.. he TAZ10 model of Quaratino et al. shows that TPO-specific T cells are sufficient to induce the histopathological and clinical features of Hashimoto disease. However, how CD8+ T cells and cytokines secreted by CD4+ T cells contribute to destruction has yet to be determined. T3, triiodothyronine. 甲状腺过氧化物酶抗体 (thyroid peroxidase antibody, TPOAb) :TPO是一种糖基化血红蛋白,跨于甲状腺细胞顶缘细胞膜上, 伸向滤泡部分具有催化活性, 直接参与甲状腺细胞中碘氧化 / 酪氨酸化及碘化酪氨酸偶联等, 是甲状腺素合成、分泌的关键酶由TPO所诱导产生的抗体即 TPOAb TSH参考值：妊期的影响 国外文献报告 Glinoer D, Spencer CA: Nat Rev Endocrinol 6: 526-529, 2010 来自8项报告，碘充足地区，抗体阴性 TSH值随妊娠期呈现上升的趋势, 提示妊娠甲减/亚临床甲减 ↑ TSH参考值：试剂的影响 * 所有妊娠时点和产前两种试剂检测值存在统计学差异（P0.001），试剂差异！ ? N TSH (Abb