苏州地区孕13~20周甲状腺功能参考范围的建立和甲状腺功能的调查  

Establishment of normal gestational age-specific reference range of thyroid hormones and investigation on thyroid diseases during 13-20 gestational week pregnancy in Suzhou

作　　者：从相国[1] 李淑湘[1] 沈琼[1] 陈蕾[1] CONG Xiangguo;LI Shuxiang;SHEN Qiong;CHEN Lei(Department of Endocrinology,Suzhou Municipal Hospital,Suzhou Affiliated Hospital of Nanjing Medical University,Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)内分泌科,江苏苏州215002

出　　处：《上海医学》2019年第11期669-673,共5页Shanghai Medical Journal

摘　　要：目的通过筛查孕13~20周的妊娠妇女甲状腺功能,建立孕13~20周妊娠特异的甲状腺功能参考范围,初步探讨妊娠妇女甲状腺疾病的患病率,为妊娠期甲状腺疾病的早发现、诊断和治疗提供相关依据。方法纳入2014年1月—2015年12月在南京医科大学附属苏州医院产科门诊进行初次产前检查的长期居住于苏州的妊娠妇女14449例(孕13~20周),筛选符合美国国家临床生物化学学会推荐的妊娠期标准人群,并从中随机选取2000例作为本研究标准人群,以标准人群促甲状腺激素(TSH)和游离甲状腺素(FT4)的第2.5,第97.5百分位数作为低值和高值,建立妊娠期特异的TSH和FT4正常值的参考范围。检测所有14449例妊娠妇女的空腹血清甲状腺过氧化物酶抗体(TPOAb)、TSH、FT4,以上述妊娠期特异的TSH和FT4参考范围为标准,探讨全部妊娠妇女甲状腺功能异常的患病情况。结果妊娠13~20周TSH参考值范围为0.07~3.62 mU/L,FT4参考值范围为11.47~18.57 pmoL/L。甲状腺功能异常总检出率为7.67%(1109/14449)。其中亚临床甲状腺功能减退的检出率最高,为3.14%(453/14449)。2014年、2015年甲状腺功能异常的检出率分别为7.04%(439/6238)、8.16%(670/8211),差异有统计学意义(χ~2=6.301,P=0.012)。TPOAb阳性总检出率为10.75%(1553/14449),2014年、2015年分别为10.76%(671/6238)、10.74%(882/8211)。结论妊娠期甲状腺功能有改变。以孕周特异的甲状腺功能参考范围为标准,妊娠期甲状腺功能异常中以亚临床甲状腺功能减退最为常见。Objective To determine the thyroid function of pregnant women during 13-20 gestational weeks,to establish normal gestational age-specific reference range of thyroid hormones,to explore the prevalence of maternal thyroid disorders,and to provide evidences for early detection,diagnosis and treatment.Methods A total of 14449 prenatal women(13-20 gestational weeks),who were long-term resident in Suzhou and received initial antenatal care between January 2014 and December 2015 in our hospital,were enrolled in this study.Two thousand women who met the National Academy of Clinical Biochemistry for pregnancy were randomly selected among them as the standard population of this study.The reference ranges of thyrotropin(TSH)and free thyroxine(FT4)in pregnancy were established with the upper and lower limits of TSH and FT4 in the standard population as the 2.5th and 97.5th percentiles.Serum thyroperoxidase antibody(TPOAb),TSH and FT4 were detected in all 14449 pregnant women.The prevalence of thyroid dysfunction during pregnancy was assessed based on the gestational age-specific reference ranges of TSH and FT4.Results The gestational age-specific reference ranges of TSH and FT4 were 0.07-3.62 mU/L and 11.47-18.57 pmoL/L,respectively.The total detection rate of thyroid dysfunction was 7.67%(1109/14449).Subclinical hypothyroidism had the highest detection rate(3.14%,453/14449).The detection rate of thyroid diseases was 7.04%(439/6238)in 2014 and 8.16%(670/8211)in 2015(χ2=6.301,P=0.012).The total detection rate of positive TPOAb was 10.75%(1553/14449);it was 10.76%(671/6238)in 2014 and 10.74%(882/8211)in 2015.Conclusion There are changes in thyroid function during pregnancy.Subclinical hypothyroidism is the leading problem in thyroid dysfunction according to gestational age-specific reference ranges for TSH and FT4.

关 键 词：妊娠 甲状腺功能试验 参考值 患病率 亚临床甲状腺功能减退症 

分 类 号：R714.256[医药卫生—妇产科学]