妊娠特异性甲状腺功能参数在评价妊娠中期甲状腺功能中的作用  

Role of trimester-specific reference intervals of thyroid hormones in evaluating thyroid function during the second trimester of pregnancy

作　　者：于晓会[1] 陈彦彦[1] 滕卫平[1] 单忠艳[1] 张丽[2] 杨柳[2] 李佳[1] 王薇薇[1] 李元宾[1] 范晨玲[1] 王红[1] 张红梅[1] 郭锐[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科、内分泌研究所,辽宁沈阳110001 [2]沈阳市妇幼保健所,辽宁沈阳110001

出　　处：《中国实用妇科与产科杂志》2010年第6期459-461,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家“十五”科技攻关计划项目(2004BA720A);卫生行业科研专项项目(200802008);辽宁省科学技术计划项目(2007225010)

摘　　要：目的探讨以妊娠特异性甲状腺功能参考范围和非妊娠人群甲状腺功能参考范围为依据的两种诊断标准在评价妊娠中期妇女甲状腺功能中的作用。方法从沈阳市妇幼保健所获得2003年7月至2004年4月在该所进行唐氏综合征筛查的1121例妊娠16～20周妇女的血清,应用固相化学发光酶免疫分析法测定血清TSH、TT4、FT4和TPOAb。分别以妊娠特异性和非妊娠人群甲状腺功能参考范围,筛查妊娠中期亚临床甲状腺功能异常的患病率。结果采用妊娠特异性甲状腺功能的参考范围,筛查妊娠中期妇女的亚临床甲减和低甲状腺素(T4)血症患病率分别为5.89%和1.52%;采用非妊娠人群的参考范围,筛查的患病率分别为1.52%和0.89%。两种诊断标准获得的亚临床甲减和低T4血症的患病率比较差异有统计学意义(P<0.001)。采用非妊娠人群的参考范围作为标准,亚临床甲减和低T4血症的漏诊率分别为4.37%和0.63%,总漏诊率为5.00%。结论采用妊娠特异性甲状腺功能指标的参考范围诊断妊娠中期亚临床甲状腺功能异常可以明显降低其漏诊率。Objective To explore the influence of tlimester-specific reference intervals and non-pregnant population reference intervals of thyroid parameters on the interpretation of thyroid function tests in pregnant women during the second trimester of pregnancy. Methods 1121 serum samples of pregnant women who received the screening for Downg syndrome at the 16th to ：20th gestational weeks from July 2003 to April 2004 in Shenyang Women and Infants healthcare center were acquired. Serum TSH ,TT4 ,FT4 and TPOAb were measured. Results The prevalence of subclinical hypothyroidism and hypothyroxinemia were 5.89% and 1.52% respectively according to trimester-specific reference intervals. The prevalence of subclinical hypothyroidism and hypothyroxinemia were 1.52% and 0.89% respectively according to non-pregnant population reference intervals. The prevalence of subclincal hypothyroidism or hypothyroxinemia according to the two different reference intervals was significantly different （ all P 〈 0.001 ）. The missed diagnostic rate of subclinical hypothyroidism and hypothyroxinemia were 4.37% and 0.63% respectively according to non-pregnant population reference intervals. Conclusion The missed diagnostic rate of subclinical thyroid abnormalities during the second trimester of pregnancy may be decreased by applying the trimester-specific reference intervals.

关 键 词：妊娠 亚临床甲状腺功能减退症 低甲状腺素血症 

分 类 号：R71[医药卫生—妇产科学]