女性妊娠期甲状腺功能减退与产后焦虑、抑郁情绪的关系

蔡海瑞　舒立波　李冬梅

[摘要] 目的 探討妊娠期甲状腺功能减退与产后焦虑、抑郁情绪的相关性及相关程度。 方法 随机选取2014年1月～2016年12月在我院高危门诊产检甲状腺功能减退的孕妇719例，同期正常孕妇548 例，在产后1、3、6及12个月对两组孕妇随防，分别利用焦虑抑郁量表（HAD）、爱丁堡产后抑郁量表（EPDS）、产后抑郁筛查量表（PDSS）评估其焦虑、抑郁症状的发生率，并分析其与促甲状腺激素（TSH）、游离甲状腺素（FT4）抗甲状腺过氧化物酶抗体（TPO-Ab）、TPO-Ab水平的相关性。 结果 ①两组相比，产后焦虑、抑郁平均分比较，差异均有统计学意义（t=4.27，8.13，P=0.000，0.006）；②产后焦虑症状发生率在产后6个月无统计学差异（χ2=0.144，P=0.705），产后1、3、12个月均有统计学意义（χ2=8.826、4.137、4.602，P=0.031、0.042、0.017）。产后抑郁的发生率在产后1、3、6个月比较，差异均有统计学意义（χ2=20.145、62.921、25.341、P=0.043、0.008、0.036），产后12个月差异无统计学意义（χ2=2.211，P=0.136）；③产后EPDS评分与 FT4水平呈负相关（r=-0.693，P=0.015），与TSH 值水平呈正相关（r=0.366，P=0.004），与TPO-Ab 是否阳性没有相关性（r=2.390，P=0.774）。 结论 产后焦虑、抑郁症状的发生与孕期甲状腺功能减退有相关性，应高度重视妊娠期甲状腺功能减退患者的孕期心理情绪疏导，产后严密随访。

[关键词] 产后抑郁；甲状腺功能减退；亚临床甲状腺功能减退；产后焦虑

[中图分类号] R749.4 [文献标识码] B [文章编号] 1673-9701（2018）12-0055-04

Relationship between hypothyroidism and postpartum anxiety and depression during pregnancy

CAI Hairui SHU Libo LI Dongmei CHEN Aner

Department of Obstetrics and Gynecology， Ningbo Women and Children's Hospital， Ningbo 315010，China

[Abstract] Objective To investigate the correlation between hypothyroidism and postpartum anxiety and depression during pregnancy. Methods From January 2014 to December 2016， 719 pregnant women with hypothyroidism and 548 normal pregnant women were selected randomLy from high-risk clinics in our hospital from January 2014 to December 2016， The incidences of anxiety and depression were evaluated by anxiety and depression scale（HAD）， Edinburgh Postnatal Depression Scale （EPDS） and Postpartum Depression Screening Scale （PDSS） respectively， and their association with thyroid stimulating hormone（TSH）， free Thyroid hormone（FT4） anti-thyroid peroxidase antibody（TPO-Ab）， TPO-Ab levels. Results ① The average postpartum anxiety and depression scores between the two groups were statistically significant （t=4.27， 8.13， P=0.000， 0.006）.② The incidence of postpartum anxiety symptoms after 6 months was not significantly different（χ2=0.144， P=0.705） while it was significantly different at postpartum 1，3 and 12 months（χ2=8.826， 4.137， 4.602， P=0.031， 0.042， 0.017）. The incidence of postpartum depression in postpartum 1，3，6 months were statistically significant（χ2=20.145， 62.921， 25.341， P=0.043， 0.008， 0.036） while there was not statistically significant after 12 months（χ2=2.211， P=0.0136）. ③There was a negative correlation between EPDS score and the level of FT4， There was a positive correlation between EPDS score and the level of TSH（r=0.366， P=0.004）， which was not correlated with whether TPO-Ab was positive （r=2.390， P=0.744）. Conclusion Postpartum anxiety and depressive symptoms are correlated with hypothyroidism during pregnancy. Psychological and emotional counseling during pregnancy should be paid great attention to during pregnancy and closely followed up during postpartum period.

[Key words] Postpartum depression； Hypothyroidism； Subclinical hypothyroidism； Postpartum anxiety

產后焦虑、抑郁情绪是指产妇在分娩后出现的情绪低落、失眠、烦躁、易激惹及快乐感的丧失，是产褥期常见的精神症状，发病机制复杂，涉及心理、躯体疾病、及家庭、社会等因素[1]，因产后焦虑、抑郁情绪发病隐匿，孕期容易被医师和患者忽略，甚至得不到家庭理解，进展为产后抑郁症才受到重视，大量的研究表明，妊娠合并甲状腺功能减退与流产、早产、低出生体重儿等不良妊娠结局密切相关，严重者直接影响后代的神经智力智力发育[2]，但与产后情绪关系的报道鲜有。……