Objective To explore the role and significance of secretory phospholipase A2(sPLA2)in peripheral blood in preterm premature rup?ture of membranes(pPROM)and infection of amniotic cavity. Methods RT-PCR was used to detect the expression levels of sPLA2 mRNA in pe?ripheral blood of 30 patients with pPROM (experimental group),30 non-full term normal pregnant patients without pPROM (normal control group)and 30 full term patients with PROM(full-term control group)before and after delivery. Fetal membranes were collected at the time of deliv?ery of patients with pPROM for pathologic examination to determine histological chorioamnionitis(HCA). Results The expression levels of sPLA2 mRNA in peripheral blood were 1.079±0.746 and 0.651±0.481 in the experimental group and the normal control group before delivery,respectively, indicating that the expression of sPLA2 mRNA was increased in the experimental group compared with the normal control group(P=0.011). The expression levels of sPLA2 mRNA in peripheral blood were 2.439±0.086 and 2.575±0.036 in the experimental group and the full-term control group at labor onset,respectively,indicating that there was no statistically significant difference in the level of sPLA2 mRNA in peripheral blood between the experimental group and the full-term control group at labor onset(P=0.787). The level of sPLA2 was related to chorioamnionitis in the experi?mental group at labor onset. Conclusion The increase of sPLA2 may participate in the pathogenesis of preterm premature rupture of membranes and is related with the infection of chorioamnionitis.

Objective To study the effects of quantitative 24-hour urinary protein on the thyroid hormone levels in patients with severe preeclamp-sia,and clarify the impact of severe urinary protein on hypothyroid in severe preeclampsia patients. Methods A total of 166 patients with severe pre-eclampsia were recruited for the study and divided into mild proteinuria group(2.0-4.9 g/d),midrange group(5-10 g/d)and severe group(>10 g/d)according to the quantitative 24-hour urinary protein. 268 healthy female individuals with normal blood pressure and uric routine in the same stage of pregnancy and of the same age were selected into control group. Serum thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine (FT4)levels were determined by solid-phase chemiluminescent enzyme immunoassay method(CMIA). The thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TGAb)concentration were detected by electrochemiluminescent assay(ECLIA). Results TSH levels were signifi-cantly higher in patients comparing to the control group(P<0.01). In addition,severe group showed higher TSH levels than mild group(P<0.01). FT4 and FT3 levels were obviously decreased with the progression of the disease(P<0.01 and P<0.05). The positive rate of TPOAb in mild group was significantly higher than that in moderate group(OR=9.8,P<0.05). There was no significant difference of the TGAb positive rate among three patient groups(P>0.05). The incidence of subclinical hypothyroidism and clinical hypothyroidism in severe group was significantly higher than that in mild group and in control group(OR=2.5,P<0.05 and OR=9.0,P<0.05;OR=8.0,P<0.01 and OR=43.4,P<0.01). Conclusion Our re-sults indicated that 24-hour urine protein in severe preeclampsia patients has extensive effects on thyroid hormones levels. With the increasing of quantitative 24-hour urinary protein,the level of TSH increased and the FT4 decreased. Thyroid autoantibody positiveness has extensive effects on 24- hour urine protein. Incidence of hypothyroid increased with the increase of quantitative 24-hour urinary protein. 24-hour urinary protein quantitative was a risk factor for hypothyroidism in severe preeclampsia patients. More attention should be paid to the monitoring of 24-hour urinary protein in se-vere preeclampsia patients.

Objective To study effects of different degree of hypothyroidism in severe preeclampsia (S-PE) pregnant women on renal function and the correlation between them.Methods 46 S-PE patients with subclinical hypothyroidism (SCH) registered for treatment in the Shengjing Hospital of China Medical University from May 2011 to March 2013 were selected into SCH group,and 23 S-PE with overt hypothyroidism (OH) were selected into OH group,and 109 S-PE with normal thyroid stimulating hormone (TSH) levels were selected into simple group.Thyroid hormone and kidney function tests were analyzed in pregnant women with S-PE.We made an analysis of the relative risk of the detection rate of abnormal renal function and also the relationship between the levels of thyroid hormone and serum uric acid,serum urea and creatinine in patients with S-PE.Results (1) In SCH group serum TSH was (6.1±3.2) mU/L,free triiodothyronine (FT3) was (4.0±0.6) pmol/L,free thyroxine (FT4) was (11.8± 1.5) pmol/L; in OH group serum TSH was (5.2± 1.3) mU/L,FT3 was (3.7±0.6) pmol/L,FT4 was (9.3±0.5) pmol/L; in simple S-PE group serum TSH was (1.9±0.8) mU/L,FT3 was (4.0±0.8) pmol/L and FT4 was (11.9±1.9) pmol/L.TSH in SCH group was significantly higher than that in simple S-PE group (P＞0.01),the difference of in SCH and OH group were not statistically significant (P＞0.05).The difference of FT3 in three groups were not statistically significant (P＜0.05) ;FT4 in OH group was significantly lower than thoes in SCH and simple groups (P＜0.05).(2)Serum uric acid,creatinine and urea levels in OH group was (436± 114),(75± 15) μmol/L and (6±3)mmol/L,in simple S-PE group they were (378± 114),(65 ±22) μmol/L and (5±3) mmol/L.In comparison,the differences was statistically significant(P＜0.05).The differences were not statistically significant in SCH and OH groups (P＞0.05).(3)The abnormal detection rate of uric acid was significantly higher in SCH than that in OH group [46％ (21/46) versus 22％ (5/23),OR=3.0,P＜0.05].The comparison of remaining index has no statistical significance(P＞0.05).(4)In SCH group there was a significant inverse correlation of serum FT3 with serum urea levels,serum creatinine and serum uric acid (r=-0.32,-0.58,-0.35,P＜0.05).There was not a correlation of serum TSH,FT4 with indicators of renal function (P＞0.05).In OH group there was a negative correlation between FT3 and serum creatinine concentrations (r=-0.40,P＜0.05).In OH group there was not a correlation of FT3 with serum uric acid and urea (P＞0.05).There was a positive correlation between TSH and serum creatinine in simple S-PE group (r=0.20,P=0.04).There was not a correlation between TSH and serum urea(r=0.04,P=0.65),and serum uric acid (r=0.12,P=0.20).Conclusions There was effect of different hypothyrosis state in pre-eclampsia patients on renal function.Serum uric acid,urea and creatinine concentrations in S-PE pregnant women with OH were significantly higher than those in simple S-PE group with normal TSH.There was a negative correlation between FT3 and serum creatinine in S-PE.Hence the thyroid function should be regularly monitored in S-PE patients to find damage of renal function and management hypothyrosis.

Objective To study thyroid hormone changes in women with pre-eclampsia patients,the characteristics of thyroid disease and its relationship with pre-eclampsia.Methods From May 2011 to December 2012 171 patients with pre-eclampsia who delivered in Shengjing Hospital of China Medical University were recruited as prc-eclampsia(PE) group,among which 114 cases were defined as early onset pre-eclampsia (EP) group and 57 cases were defined as late onset pre-eclampsia (LP) group.And 171 healthy women with same age and same stage of pregnancy were selected as the control group.Their blood pressures were normal and they had no obstetrical complications.Serum thyrotropin (TSH),free triiodothyronine (FT3) and free thyroxine (FT4) levels were determined by solid-phase chemiluminescent enzyme immunoassay method (CMIA).Thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) were measured by electro-chemiluminescent assay (ECLIA).The positive rate was calculated (TPOAb ＞ 5.6 U/L,TGAb ＞ 4.1 U/L were defined as positive result).The relationship between TSH,FT3,FT4 level and blood pressure was analyzed in women with pre-eclampsia.Results (1) The median values of TSH,FT4 and FT3 in PE group were 3.4 mU/L,(12.0 ± 3.0) pmol/L and(3.9 ± 0.9) pmol/L.In the control group,they were 1.9 mU/L,(13.4 ± 2.4) and (5.0 ± 1.3) pmol/L.There were statistically significant differences between the two groups(P ＜ 0.01).In EP group,the median values of TSH,FT4 and FT3 were 3.3 mU/L,(12.1 ± 3.4) pmol/L and (3.8 ± 0.9) pmol/L.The differences between EP group and the control group were statistically significant (P ＜ 0.01).In LP group,the median values of TSH,FT4 and FT3 were 3.4 mU/L,(11.9 ± 3.1) pmol/L and (3.9 ± 1.0) pmol/L.There were statistically significant differences compared to the control group(P ＜0.01).While there was no difference between EP group and LP group (P ＞ 0.05).(2) The positive rate of TPOAb and TGAb in PE group were 15.2％ (26/171)and 21.6％ (37/171),and were 12.3％ (21/171) and 14.6％ (25/171) in the control group.There was statistically significant difference in the TGAb positive rate (P ＜ 0.01),but the difference in TPOAb positive rate was not statistically different(P ＞0.05).The TPOAb positive rates in EP group and LP group were 12.3 ％ (14/114) and 21.1％ (12/57),respectively,with no statistically significant difference (P ＞ 0.05).And the positive rates of TGAb in EP group and LP group were 21.9％ (25/114)and 21.1％ (12/57),respectively,with no statistically significant difference(P ＞ 0.05).The positive rate of TPOAb in LP group and in the control group had statistically significant difference(P ＜0.01).(3) The morbidity of thyroid disease in PE group and in the control group were 47.4％ (81/171) and 16.4％ (28/171),with statistically significant difference (P ＜ 0.01).(4) The morbidity of subclinical hypothyroidism or hypothyroidism in PE group and in the control group were 45.0％ (77/171) and 16.4％ (28/171),with statistically significant difference(P ＜0.01).(5) The morbidity of subclinical hyperthyroidism in PE group and in the control group were 2.3 ％ (4/171) and 1.8 ％ (3/171),with no statistically significant difference (P＞0.05).(6) In PE group,women with TSH level of 0.3-3.3 mU/L had systolic pressure of(170 ± 21)mmHg (1mmHg =0.133 kPa)and diastolic pressure of(112 ± 15) mmHg; women with TSH ＞ 3.3 mU/L had systolic pressure of(166 ± 21)mmHg and diastolic pressure of(109 ± 13)mmHg.There was no statistically significant difference(P ＞ 0.05).But the diastolic pressure in EP group and LP group had statistically significant difference(P ＜ 0.01).In PE group,no correlation was found among TSH,FT4 levels and systolic pressure,diastolic pressure(P ＞ 0.05).FT3 level was negatively correlated to diastolic pressure (r =-0.172,P =0.023).Conclusions It is common that pre-eclampsia is complicated with thyroid dysfunction,mainly subclinical hypothyroidism.Thus it is nessesary to test thyroid hormone and thyroid antibodies in women with pre-eclampsia.The decrease of FT3 and FT4,the increase of TSH and the presence of TPOAb and TGAb are related with the presence of pre-eclampsia.

Objective To use the first trimester-specific reference intervals of thyroid-related hormones to explore the prevalence of thyroid dysfunction during early pregnancy and to analyze effectiveness of different screening strategies. Methods In this study 2 899 pregnant women were enrolled during the first trimester of gestation. TSH, FT4, FT3, and thyroid peroxidase antibody (TPOAb) were measured and thyroid disorders of pregnant women were diagnosed based on the first trimester-specific reference intervals. Results The prevalence of hypothyroidism was significantly higher in the high-risk group than in the non-high risk group ( 16.3% vs 5.3%,RR = 3.1,95% CI 2.4-4.0, P＜0.01 ). TPOAb ( RR = 4.7, 95 % CI 3.6-6.0, P＜0.01 ), and personal history of thyroid diseases ( RR=3.2, 95% CI 1.9-5.4, P＜0.01 ) increased the risk of hypothyroidism. The prevalence of hyperthyroidism was higher in the high-risk group (3.1% vs 1.4%, P = 0. 006, RR = 2.2, 95% CI 1.2-3.9, P=0.006). TPOAb (RR=2.6, 95%CI 1.3-5.0, P=0.007), and presence of personal history of thyroid diseases( RR=4.7, 95% CI 1.7-12.5, P=0.006) also increased the risk of hyperthyroidism. 56.7% women with hypothyroidism and 64. 7% women with hyperthyroidism were in the non-high risk group. Conclusion We recommend that screening all pregnant women for thyroid disorders in the first trimester with TSH, FT4, and TPOAb is more effective than the case-finding approach.

Objective To investigate the prevalence of hypothyrodism during the first half of pregnancy in the Han nationality women in iodine-adequate area. Methods TSH, FT4 and thyroid peroxidase antibody (TPOAb) levels were detected in 4 800 pregnant women during the first half of pregnancy. Both gestational age-specific reference intervals and population-based reference intervals of thyroid function were applied and the corresponding prevalences of hypothyroidism were compared with each other. Results Based on the gestational age-specific reference intervals, the prevalences of overt hypothyroidism at 4th and 8th weeks of gestation were 1.03%, 0.37% respectively. At 4th, 8th, 12th, 16th and 20th weeks of gestation, the prevalences of subclinical hypothyroidism were 4.59%, 6.15% , 4.68%, 4.53%, 5.96% respectively, while those of hypothyroxinemia were 3.69%, 1.11%, 2.92% , 1.29%, 2.29%, respectively. According to the pepulation-based reference intervals, the rates of missed diagnosis of subclinical hypothyroidism were 0.18%, 2.85%, 4.10%, 3.24%, 3.21% while those of hypothyroxinemia were 3.45%, 0.66%, 2.34%, 1.29%, 1.83%, respectively. During 4th, 8th, 16th weeks of gestation, the positive rates of TPOAb in the group with subclinical hypothyroidism were significantly higher than those with euthyroidism. The prevalences of subclinical hypothyroidism in TPOAb positive group were obviously higher than those in TPOAb negative group at 4th, 8th, 12th, 16th gestational weeks. Conclusion The rates of missed diagnosis of subclinical hypothyroidism and hypothyroxinemia during the first half of pregnancy were decreased by applying the gestational age-specific reference intervals in this prospective study. Positive TPOAb is a risk factor for subclinical hypothyroidism during the first half of pregnancy.

Objective To investigate the prevalence of gestational transient thyrotoxicosis(GTT) and analyze the cause of thyrotoxicosis encountered in this period MethodsAn epidemiologic survey in ten hospitals in Shenyang was performed and 534 pregnant women during the first trimester of pregnancy filled questionaire,received physical examination and had serum thyroid-stimulating hormone(TSH),free T4 (FT4),free T3(FT3),thyroid peroxjdase antibody(TPOAb),thyrotrophin receptor antibody(TRAb),and human chorionic gonadotrophin(hCG)tests.Results(1)The total prevalence of thyrotoxicosis was 9.75%(52/534)in the first trimester and the prevalence of Grrr was 7.86%.which accounted for 80.77%of the thyroxicosis encountered in this period.A total of 88.89%of the overt GTT showed only elevated FT3 level.(2)The level of serum hCG increased gradually in the first trimester.The medians of hCG were 25 300,85 220 and 81 780 IU/L 6,8-10 and 12 weeks after gestation.respectively(P=0.000).The medians of serum TSH were 1.45.1.10 and 0.84 mlU/I,6.8-10 and 12 weeks after gestation,respectively(P＜0.01).(3)When segum hCG was more than 50 000 IU/L,the prevalece of GTT increased obviously.When serum hCG was between 80000 IU/L and 110000 IU/L,subclinical GTT increased significantly.When serum hCG was more than 110000 IU/L,overt GTT increased significantly.Correlation analysis showed that serum hCG was related negatively with TSH(r=-0.402,P=0.000)and positively with FT3(r=0.165,P=0.000),but not related with FT4.Conclusions The prevalence of GTT is 7.86%in the first trimester and it is the main cause of thyrotoxicosis found in the first trimester,accounting for 80.77%of all the causes.The serological characteristic of overt GTT is mainly the elevation of serum FT3 leveL Serum hCG level is related with the severity of GTT.

Objective To establish the gestational month-specific reference intervals for thyrotropin and thyroxine in Han nationality women in iodine sufficient area of China. Methods In iodine sufficient area of China, 120 non-pregnant women and 1 118 pregnant women at gestational ages from 4 to 36 week (4 weeks≈1 month) were collected according to the strict criteria. Urinary iodine excretion and serum thyrotropin (TSH), total thyroxine (TT4), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb) levels were determined in all subjects. Results During pregnancy, serum TSH increased at week 4, and then began to decrease with the lowest level at week 12, which was 35% lower than the non-pregnant level." After that, serum TSH increased gradually and finally became stable during the third-trimester of pregnancy (T3) when the level was 29% higher than that of non-pregnant controls. Serum TT4 elevated dramatically during the first-trimester with peak at week 16, which increased by 70% compared with the non-pregnant level, then slightly decreased, and became steady with 50% increasing compared with non-pregnant level. Serum FT4 initially increased slightly with peak at week 4, and then decreased gradually until the beginning of T3 without obvious fluctuation during T3. Conclusion The gestational month-specific reference intervals for TSH, TT4 and FT4 are necessary for the early diagnosis of maternal subclinical hypothyroidism and hypothyroxinaemia.

Objective To prospectively observe the effect of levothyroxine treatment on neuropsychological development in offspring of pregnant women with subclinical hypothyroidism. Methods Twenty-three pregnant women with subclinical hypothyroidism received levothyroxine therapy (SCH+LT4 group) and 17 who did not receive levothyroxine ( SCH group) were enrolled; 24 pregnant women with normal thyroid function were referred as controls (C group). All the subjects underwent the planned thyroid tests regularly. Serum TSH, TT4, FT4, TT3,FT3, TPOAb, and TgAb levels were determined. Their 14-30 month-old children underwent the tests relating to intelligence and motor activity with the Bayley scale. Results In SCH group, SCH+LT4 group, and C group, the MDI were 115. 12, 118.56, and 117.63, respectively. And the PDI were 115.47, 120.65, and 117.50,respectively. The MDI and PDI were the highest in SCH+LT4 group and were the lowest in SCH group. Serum TSH levels remained above 2.0 mIU/L during the whole course of pregnancy in SCH group and higher than that in C group at all time points ( P＜0.05 ). Serum TT4 and FT4 levels were lower in SCH group than in C group at all time points except G28 and G32. The baseline TSH level in SCH+LT4 group was the highest ( P＜0.01 ), their TT4 and FT4 levels were the lowest among the three groups. In SCH + LT4 group, serum TSH, TT4, and FT4 levels were similar to C group after L-T4 treatment. Conclusion The prompt L-T4 treatment can maintain normal TSH levels in pregnant women with subclinical hypothyroidism during the whole course of pregnancy, and impairment of neuropsychological development in infants may be avoided.