妊娠和产后甲状腺疾病诊治指南.ppt

筛查的理由诊断手段：血清TSH、FT4、TPOAb，价格便宜广泛可得，指标可靠治疗手段：L-T4经济、有效、安全患者筛查治疗意愿强烈：优生优育的保障，我国的国情、政府项目成本-效益分析：筛查优于不筛查早妊（头三月）:TSH≯2.5中妊（中三月）:TSH≯3.0ThankyouForourmothersandchildren愿母婴安全健康！愿中华民族素质不断提高！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：JCEM2010，95：4227-4234Nonverbal: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PopVJ：ClinEndocrinol（Oxf）2003，59：282-288Mental:智力；motor:运动与正常对照，甲减者智力和运动能力随时间↓*#Comparedtocontrolgroup*p=0.004；#p=0.007分组No.PDIX±SDMDIX±SD低T4血症19112.32±15.10*112.21±12.26#正常对照组38121.61±7.94119.78±7.76LiYB,ShanZY：ClinEndocrino;(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.?TheTAZ10transgenicmousemodel10andtheimmunologicalbasisforHashimotothyroiditis.

(a)Thyroidfollicleandthelocationofthemajorthyroidautoantigens:thyroidperoxidase(TPO),thyroglobulin(Tg)andthethyroid-stimulatinghormonereceptor(TSHR).(b)Immunologicalmechanismsleadingtothespectrumofhumanautoimmunitywithdifferingpathologicalandclinicalcharacteristics.GraveshyperthyroidismiscauseddirectlybyTSHRautoantibodiesthatactivatetheTSHR.HypothyroidisminHashimotothyroiditisisassociatedwithautoantibodiestoTPO(andlesscommonlytoTg),buttherelativecontributionstothyrocytedamagebyautoantibodies,TPO-specificTcellsand/orcytokinesisunknown..heTAZ10modelofQuaratinoetal.showsthatTPO-specificTcellsaresufficienttoinducethehistopathologicalandclinicalfeaturesofHashimotodisease.However,howCD8+TcellsandcytokinessecretedbyCD4+Tcellscontributetodestructionhasyettobedetermined.T3,triiodothyronine.甲状腺过氧化物酶抗体(thyroidperoxidaseantibody,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