宁波地区妊娠妇女甲状腺激素水平变化及功能减退症的调查  

Changes of thyroid hormone levels and prevalence of hypothyroidism during pregnancy

作　　者：李春仙[1] 陈洁[1] 苏敏敏[2] 叶元芬[2] 朱虹[2] 陈维[3] 苏晓娇 

机构地区：[1]宁波大学医学院附属医院检验科,315020 [2]宁波大学医学院附属医院产科,315020 [3]宁波大学医学院附属医院超声科,315020 [4]宁波江北妇保所检验科

出　　处：《浙江医学》2013年第8期666-668,677,共4页Zhejiang Medical Journal

基　　金：宁波大学医学院院级基金(201040)

摘　　要：目的研究宁波地区妊娠妇女在妊娠期间甲状腺激素水平的变化趋势及在妊娠过程中甲状腺功能减退症(甲减)的发生情况。方法选取妇产科门诊开展妊娠期甲状腺疾病流行病学调查的1 281例妊娠妇女作为妊娠组,同期体检的163例健康非妊娠妇女作为对照组,采集所有受检者空腹血标本(妊娠组自孕4周起每隔4周1次,至临产时),应用化学发光法测定血清游离甲状腺素(FT_4)、游离三碘甲状腺原氨酸(FT_3)、总甲状腺素(TT_4)、总三碘甲状腺原氨酸(TT_3)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPO-Ab)。结果妊娠组血清FT4在孕4、8周与对照组的差异无统计学意义(P>0.05),从孕12周开始下降,孕24周降至最低点,此后一直维持在低水平;丌4从孕4周开始即高于对照组,在孕12周升至高峰,孕24周后一直维持在孕4、8周水平;TT_3变化趋势与TT_4相似;TSH在孕4周即低于对照组,至孕12周降至最低,随后逐渐回升,孕36周恢复正常水平,临产时高于对照组;妊娠组检出各种甲减140例,检出率10.93%,TPO-Ab阳性1 14例,阳性率8.90%;对照组检出各种甲减7例,检出率4.29%,TPO-Ab阳性18例,阳性率为11.04%。两组各种甲减检出率的差异有统计学意义(P<0.01),TPO-Ab阳性检出率的差异无统计学意义(P>0.05)。结论妊娠妇女甲状腺激素水平随妊娠月份不断变化,应开展妊娠期甲状腺功能常规筛查。Objective To investigate the changes of thyroid hormone levels and occurrence of hypothyroidism during pregnancy. Methods Total 1 281 pregnant women who visited Ningbo University Affiliated Hospital and Ningbo Jiangbei Mater-nal Health Hospital from August 2010 to October 2011, 163 non-pregnant women were included in the study. Serum free thyrox-ine（FT4）, free tri odothyronine （FT3）, total thyroxine （TT4）, total triiodothyronine （TT3）, thyrotropin （TSH） and thyroid peroxidase anti-body （TPO-Ab） were measured in al subjects. Results Serum FT4 in pregnant women started to decrease at G12 and reached the minimal level at G24, then remained at low level til the end of the pregnancy. TT4 and TT3 increased to the peak at G12 and G16, then remained at high level. TSH decreased at G4 and went to the lowest level at G12, then increased gradual y and returned to normal levels at G36, it was higher than non-pregnant women at the period of labor. The prevalence of hypothyroidism and positive TPO-Ab among pregnant women were 10.93%（140/1 281） and 8.90%（114/1 281）, respectively;those in non-pregnant women were 4.29%（7/163） and 11.04%（18/163）, respectively. There was significant difference in the prevalence of hypothyroidism （P〈0.01） and no significant difference in prevalence of positive TPO-Ab （P 〉0.05） between pregnant women and non-pregnant women. Conclusion The levels of serum thyroid hormones fluctuate during the pregnancy. The high prevalence of hypothyroidism during the pregnancy indicates that the screening for thyroid function should be recommended in pregnant women.

关 键 词：妊娠 甲状腺激素 甲状腺自身抗体 甲状腺功能减退症 

分 类 号：R714.2[医药卫生—妇产科学]