妊娠相关蛋白A联合甲状腺过氧化物酶抗体对亚临床甲状腺功能减退合并妊娠期高血压患者的妊娠结局预测

doi:10.3969/j.issn.1006-5725.2026.08.019

摘要/Abstract

摘要：

目的探讨妊娠相关蛋白A（PAPP-A）联合甲状腺过氧化物酶抗体（TPO-Ab）对亚临床甲状腺功能减退合并妊娠期高血压患者妊娠结局的预测价值。方法选取医院于2020年1月至2025年1月收治的186例妊娠期亚甲减孕妇，根据患者是否合并妊娠期高血压分为亚甲减组（n = 87）和亚甲减合并妊高组（n = 99），同时选取102例同期正常妊娠孕妇设为对照组。收集所有孕妇的基本资料，并检测其血清中PAPP-A和TPO-Ab水平。随访记录亚甲减合并妊高组孕妇流产、早产、产后出血等不良妊娠结局发生情况，利用logistic回归分析筛选患者妊娠不良结局的风险因素，并通过ROC曲线评估血清PAPP-A、TPO-Ab水平对妊娠结局的预测价值。结果亚甲减合并妊高组的PAPP-A低于亚甲减组和对照组，但TPO-Ab水平更高，差异有统计学意义（P < 0.05）。随访结果显示，99例亚甲减合并妊高组孕妇不良结局占比为46.46%（46/99），多因素分析结果表明，TPO-Ab升高以及PAPP-A降低是患者出现不良妊娠结局的风险因素（P < 0.05）。ROC曲线显示，PAPP-A联合TPO-Ab对患者妊娠结局的评估准确度较高。结论 PAPP-A降低与TPO-Ab升高是亚临床甲状腺功能减退合并妊娠期高血压患者不良妊娠结局的风险因素，二者联合对该类患者的妊娠结局具有较高预测价值。

关键词: 妊娠期甲状腺功能减退, 妊娠期高血压, 妊娠相关蛋白A, 甲状腺过氧化物酶抗体, 妊娠结局

Abstract:

Objective To explore the predictive value of pregnancy-associated plasma protein A （PAPP-A） combined with thyroid peroxidase antibody （TPO-Ab） for pregnancy outcomes in patients with subclinical hypothyroidism complicated with gestational hypertension. Methods A total of 186 pregnant women with subclinical hypothyroidism admitted to the hospital from January 2020 to January 2025 were selected. They were divided into the subclinical hypothyroidism group （n = 87） and the subclinical hypothyroidism combined with gestational hypertension group （n = 99） based on the presence of gestational hypertension. Meanwhile， 102 normal pregnant women during the same period were enrolled as the control group. Basic data of all pregnant women were collected， and their serum levels of PAPP-A and TPO-Ab were detected. The occurrence of adverse pregnancy outcomes such as abortion， preterm birth， and postpartum hemorrhage in the subclinical hypothyroidism combined with gestational hypertension group was followed up and recorded. Logistic regression analysis was used to screen the risk factors for adverse pregnancy outcomes， and ROC curves were employed to evaluate the predictive value of serum PAPP-A and TPO-Ab levels for pregnancy outcomes. Results The serum PAPP-A level in the subclinical hypothyroidism combined with gestational hypertension group was lower than that in the subclinical hypothyroidism group and the control group， while the TPO-Ab level was higher， with statistically significant differences （P < 0.05）. Follow-up results showed that 46.46% （46/99） of the 99 pregnant women in the subclinical hypothyroidism combined with gestational hypertension group had adverse outcomes. Multivariate analysis indicated that elevated TPO-Ab and decreased PAPP-A were risk factors for adverse pregnancy outcomes （P < 0.05）. ROC curve analysis revealed that the combination of PAPP-A and TPO-Ab had high accuracy in evaluating the pregnancy outcomes of the patients. Conclusion Decreased PAPP-A and elevated TPO-Ab are risk factors for adverse pregnancy outcomes in patients with subclinical hypothyroidism complicated with gestational hypertension， and their combination has high predictive value for the pregnancy outcomes of such patients.

Key words: subclinical hypothyroidism in pregnancy, gestational hypertension, pregnancy-associated plasma protein A, thyroid peroxidase antibody, pregnancy outcome

中图分类号:

R581.2

郑雪琴,胡英. 妊娠相关蛋白A联合甲状腺过氧化物酶抗体对亚临床甲状腺功能减退合并妊娠期高血压患者的妊娠结局预测[J]. 实用医学杂志, 2026, 42(8): 1444-1449.

Xueqin ZHENG,Ying HU. Prediction of pregnancy outcomes by PAPP-A combined with TPO-Ab in patients with subclinical hypothyroidism complicated with gestational hypertension[J]. The Journal of Practical Medicine, 2026, 42(8): 1444-1449.

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组别	例数	年龄/岁	孕周/周	孕前BMI/（kg/m²）
对照组	102	28.78 ± 3.75	29.02 ± 2.41	22.42 ± 3.31
亚甲减组	87	29.15 ± 4.20	28.71 ± 2.35	22.72 ± 3.54
亚甲减合并妊高组	99	29.34 ± 4.36	28.94 ± 2.39	22.96 ± 3.61
F值		0.484	0.419	0.606
P值		0.617	0.658	0.546

组别	例数	PAPP-A/（U/L）	TPO-Ab/（IU/mL）
对照组	102	7.78 ± 1.76	25.71 ± 3.81
亚甲减组	87	5.79 ± 1.24	34.29 ± 5.06
亚甲减合并妊高组	99	4.98 ± 0.86	44.56 ± 6.25
t值		114.681	339.915
P值		<0.05	<0.05

影响因素	结局不良组（n = 46）	结局良好组（n = 53）	t值	P值
年龄/岁	29.01 ± 4.13	29.63 ± 4.25	0.733	0.465
孕前BMI/（kg/m²）	22.81 ± 3.32	23.10 ± 3.44	0.425	0.672
孕周/周	29.03 ± 2.54	28.87 ± 2.35	0.325	0.746
TC/（mmol/L）	5.60 ± 0.98	5.54 ± 0.95	0.309	0.758
TG/（mmol/L）	3.11 ± 0.69	3.04 ± 0.64	0.523	0.602
LDL-C/（mmol/L）	2.62 ± 0.58	2.60 ± 0.51	0.183	0.856
HDL-C/（mmol/L）	1.15 ± 0.38	1.18 ± 0.39	0.386	0.700
TSH/(mIU/L)	4.12 ± 0.74	3.89 ± 0.57	1.744	0.084
TT3/ (nmol/L)	2.31 ± 0.45	2.34 ± 0.49	0.316	0.753
FT3/ ( pmol/L)	5.75 ± 0.67	5.58 ± 0.55	1.386	0.169
TT4/(nmol/L)	116.94 ± 23.49	115.19 ± 21.98	0.383	0.703
FT4/ ( pmol/L)	17.15 ± 3.52	16.72 ± 3.40	0.617	0.538

组别	例数	PAPP-A/（U/L）	TPO-Ab/（IU/mL）
结局不良组	46	3.78 ± 0.75	51.02 ± 7.81
结局良好组	53	6.03 ± 1.24	38.96 ± 5.15
t值		10.718	9.179
P值		<0.05	<0.05

项目	B	标准误差	Wald	显著性	Exp(B)	下限	上限
PAPP-A	-2.319	0.591	15.425	0.000	0.098	0.031	0.313
TPO-Ab	0.216	0.064	11.274	0.001	1.242	1.094	1.409
常量	1.127	3.332	0.114	0.735