妊娠期甲状腺功能动态变化：自我纵向序列研究  

Dynamic changes of thyroid function during gestation： A self-sequential longitudinal study

作　　者：张晓梅 姚宝婷 王丹阳 李晨嫣[2] 单忠艳[2] 滕卫平[2] 

机构地区：[1]丹东市第一医院内分泌科,118000 [2]中国医科大学附属第一医院内分泌科内分泌研究所辽宁省内分泌疾病重点实验室,沈阳110001

出　　处：《中华内分泌代谢杂志》2014年第12期1053-1057,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家临床重点专科建设项目;科技部973科学计划基金前期项目（2011CB512112）;国家自然科学基金（81170730）;十二五科技支撑计划项目（NO2014BAI06B02）;卫生部行业科研专项基金（201002002）;辽宁省科技厅基金（2012225020）;辽宁省医学高峰建设工程项目（辽卫函字[2010]696号）

摘　　要：目的 观察正常妊娠妇女甲状腺功能评估指标妊娠特异性参考范围及其动态变化.方法 139名正常妊娠妇女进入自我纵向随访序列,分别在妊娠8周、12周、16周、20周、28周、36周及产后3个月、6个月采样并检测甲状腺功能相关指标.301名育龄正常妇女为非妊娠对照组.结果 血清促甲状腺激素（TSH）中位数于妊娠早期最低,妊娠中期、晚期升高,TSH参考范围分别为0.20 ～ 4.01 mIU/L、0.43～3.97 mIU/L、0.57～3.96 mIU/L.游离甲状腺素（FT4）自妊娠12周至产后6个月逐渐降低且低于非妊娠水平.总T4（TT4）妊娠12周显著增加,此后较稳定至产后恢复正常.游离三碘甲状腺原氨酸（FT3）妊娠12周至28周逐渐降低,产后逐渐恢复正常.总T3（TT3）在妊娠第12周显著增加,此后较稳定至产后恢复正常.妊娠早期TSH和FT4之间存在显著负相关（P＜0.01）.整个妊娠期TSH和TT4之间没有相关性（P＞0.05）.从妊娠12周至产后6个月,FT4和TT4、FT3和TT3呈正相关（P＜0.01）.结论 采用自我纵向序列人群建立的妊娠期TSH参考范围缩窄,但上限仍高于国外指南的建议.Objective To evaluate the trimester specific reference ranges and dynamic changes of thyroid functional indicators during gestation of healthy pregnant women.Methods According to the selection criteria,139 cases were selected as the normal pregnant population to establish a self-sequential longitudinal reference range.We collected samples eight times in every case throughout the gestation（including the 8th,12th,16th,20th,28th,36th week of prenatal,the 3rd and the 6th month postpartum） and detected the indicators of thyroid funciton.Meanwhile,301 healthy non-pregnant women of childbearing age were selected as the control group.Results The median of TSH was lowest in the first trimester,and then was increased in the second and third trimesters.The reference ranges of TSH were 0.20-4.01 mIU/L,0.43-3.97 mIU/L,and 0.57-3.96 mIU/L in the above trimesters.The free thyroxine （FT4） level from the 12th week of gestation to the 6th month of postpartum was gradually decreased and was lower than the non-pregnant level.The total thyroxine （TT4） was significantly increased at the 12th week of gestation and thereafter it was stable and returned to normal after childbirth.The free triiodothyronine（FT3） was gradually declined from the 12th week to the 28th week and returned to normal postpartum.Total triiodothyronine（TT3） was significantly increased at the 12th week and thereafter was stable,and returned to normal after childbirth.There was a significant negative correlation between TSH and FT4 in the first trimester（P＜0.01）.There was no correlation between TSH and TT4 during the whole gestation.There were positive correlations between FT4 and TT4,FT3 and TT3 since the 12th week of gestation （P ＜ 0.01）.Conclusions The gestational specific reference range of TSH based on the selfsequential longitudinal study was narrow,however,the upper limit was still higher than that recommended in foreign guidelines.

关 键 词：自我序列 纵向 参考范围 甲状腺功能 妊娠 

分 类 号：R714.1[医药卫生—妇产科学]