妊娠早中期甲状腺功能减退的筛查  

Screen of subclinical hypothyroidism and hypothyroidism in the first and second trimester of pregnancy

作　　者：王春芳[1] 徐焕[1] 程海东[1] 李笑天[1] 

机构地区：[1]复旦大学附属妇产科医院产科,上海200011

出　　处：《医药论坛杂志》2013年第4期3-6,共4页Journal of Medical Forum

基　　金：复旦附属妇产科医院2010年国家临床重点专科建设项目基金

摘　　要：目的制定妊娠早中期血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3),游离四碘甲腺原氨酸(FT4)的参考值范围,筛查上海市妊娠期妇女甲减和亚临床甲减的患病率。方法 2011年8月至2012年4月共10264例复旦附属妇产科医院产科门诊正规建卡的早中孕期单胎妊娠孕妇,晨8点至11点抽取5ml静脉血,分离血清后检测TSH、FT3、FT4、总T3(TT3)、总T4(TT4)、TPO-Ab。黄浦院区的甲状腺功能检测使用西门子化学发光仪,杨浦院区则使用雅培I2000化学发光仪,均使用配套的试剂盒采用直接化学发光技术的竞争免疫测定法进行检测。结果早孕期TSH参考值为0.04～3.61μIU/ml(雅培)、0.02～3.24μIU/ml(西门子),FT3参考值为3.60～5.81pmol/L(雅培)、3.58～5.41pmol/L(西门子),FT4参考值为12.32～21.66pmol/L(雅培)、11.85～21.26pmol/L(西门子)。中孕期TSH参考值为0.09～3.93μIU/ml(雅培)、0.09～4.57μIU/ml(西门子),FT3参考值为3.70～5.95pmol/L(雅培)、3.30～5.22pmol/L(西门子),FT4参考值为11.19～19.14 pmol/L(雅培)、10.68～17.65pmol/L(西门子)。亚临床甲减患病率2.8%,甲减患病率0.08%。结论上海地区早中孕期TSH参考值上限显著高于美国甲状腺协会推荐TSH参考值。Objective To establish gestational age - specific reference intervals for serum thyrotropin, free triiodothyro- nine（ FT3 ）,free thyroxine （FT4） and acquire the prevalence of subclinical hypothyroidism and hypothyroidism in the first and second trimester of pregnancy in Shanghai. Methods Totally 10264 pregnant women in the first and second trimester of pregnancy were recruited from Aug 2011 to Apr 2012 in the Obstetrics and Gynecology Hospital of Fndan Uni- versity. Serum thyrotropin, free triiodothyronine, free thyroxine and thyroid peroxidase antibody levels were determined by 2 kinds of detection reagents：Abbott Architect I2000 and Siemens immulitel000 in two districts of the hospital. Results The reference intervals of TSH, FT3 and FT4 in the first trimester of pregnancy is 0. 04 - 3.61ulU/ml, 3.60 5.81pmol/L, 12. 32 -21.66pmoL/L for Abbott Architect I2000 and 0. 02 - 3.24uIU/ml, 3.58 - 5.41pmoL/L, 11.85 - 21.26pmol/L for Siemens immulitel000. The reference intervals of TSH, FT3 and FT4 in the second trimester of preg- nancy is 0. 09 ~ 3.93uIU/ml, 3.70 - 5.95pmo1/L, 11.19 - 19. 14 pmol/L for Abbott Architect 12000 and 0. 09 4. 57ulU/m1,3.30 - 5.22pmol/L, 10. 68 - 17.65pmol/L for Siemens immulitcl000. The prevalence of subclinical hypothyroidism and hypothyroidism in Shanghai. Conclusions The reference value upper limit for serum thyrotropin in Shanghai is higher than the recommended value of American Thyroid Association.

关 键 词：妊娠 甲状腺功能减退症 亚临床甲状腺功能减退症 甲状腺激素 促甲状腺激素 参考值 

分 类 号：R582.2[医药卫生—内分泌]