不同孕期孕妇甲状腺功能相关指标分析  

Analysis of the trimester-specific thyroid function-related parameters in pregnant women

作　　者：韩娜[1] 时立新[1] 朱严严[3] 雷后康[2] 彭年春[1] 

机构地区：[1]贵阳医学院附属医院内分泌科,550004 [2]贵阳医学院附属医院妇产科,550004 [3]贵州省人民医院放射科

出　　处：《中华内分泌代谢杂志》2012年第6期480-482,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨不同孕期孕妇甲状腺激素水平变化及其与抗甲状腺过氧化物酶抗体（TPOAb）之间的关系。方法377例不同孕期的孕妇，采用固相化学发光酶免疫分析法（ICMA）测定血清促甲状腺激素（TSH）、游离甲状腺激素（FT4）、游离三碘甲状腺原氨酸（FT3）、总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）、TPOAb。结果正常组孕妇早、中、晚期TSH中位数依次上升（均P〈0．05）．TPOAb阳性组TSH中位数高于TPOAb阴性组（P〈0．05），TPOAb阳性组中临床和亚临床甲状腺功能减退症（甲减）的患病率高于TPOAb阴性组（P〈0．05）。采用FT4及TT4诊断法诊断亚临床甲减患病率分别为18．04％及23．61％；采用TT4及FT4诊断临床甲减的患病率分别为0．27％及5．84％（P〈0．05）。结论应当重视FT4和TT4在妊娠中晚期甲减诊断的差异；应建立孕期正常的甲状腺激素切点值并开展TPOAb的筛查。Objective To study the variation of serum thyroid hormones in each trimester of pregnancy and their relationship with thyroid peroxidase antibody（TPOAb）. Methods Three-hundred and seventy-seven pregnant women in different trimesters were enrolled, the serum TSH, FT3 , FT4 , TT3, TT4 , and TPOAb were determined by ICMA assay. Results Serum TSH in normal pregnant group was gradually increased as the pregnant trimester grew up （all P〈0.05 ）. The median of TSH in positive TPOAb group was higher than that of negative TPOAb group （P〈 0.05 ）. The prevalences of both clinical and subclinical hypothyroidism in positive TPOAb group were also higher than those in negative TPOAb group （ all P 〈 0.05 ）. The prevalences of subclinical hypothyroidism were 23.61% and 18.04% , while those of clinical hypothyroidism were 0.27% and 5.84% by using TT4 and FT4 determination, respectively（P〈0.05 ）. Conclusions More attention should be paid to the difference between FT4 and TF4 in hypothyroidism diagnosis during both second and third trimesters of pregnancy. Establishment of normal thyroid hormones cut-off points in each trimester of pregnancy and screening for TPOAb is necessary.

关 键 词：妊娠 甲状腺激素 抗甲状腺过氧化物酶 

分 类 号：R714.25[医药卫生—妇产科学]