正常碘摄入水平下妊娠特异性甲状腺指标参考值建立研究  

Study on the establishment of trimester - specific reference intervals of thyroid hormones for pregnancy under normal iodine intake

作　　者：李彩球 范冬春 王晓迪 

机构地区：[1]永康市第一人民医院产科,浙江省永康321300

出　　处：《中国基层医药》2018年第5期553-556,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划项目（201423）

摘　　要：目的建立正常碘摄入水平下妊娠特异性甲状腺指标的参考值范围。方法选取接受常规产检的妊娠妇女716例为试验组，并以年龄匹配的非妊娠女性307例为对照组，采用化学发光微粒子免疫法检测血清促甲状腺激素（TSH）、游离甲状腺素（n）、游离三碘甲状腺原氨酸（FT3）水平，分析不同妊娠期特异性甲状腺指标的变化，制定特异性甲状腺各指标的参考值范围。结果非妊娠女性、不同妊娠期女性血清TSH、FT，和FT4的表达水平差异均有统计学意义（F=78．901、249．571、137．090，均P〈0．05），其中TSH值随孕周增加呈上升趋势，而FT3和FT4随孕周增加呈降低趋势；早、中、晚妊娠期血清TSH参考范围分别为0．12—4．82miU／L、0．60—4．25miU／L、0．37—4．03miU／L，FT3参考范围分别为3．81—6．10pmol／L、3．40—5．20pmol／L、3．00-5．00pmol／L，FT4参考范围分别为12．85—22．12pmol／L、10．81—17．66pmol／L、10．96—18．20pmol／L；该研究建立的参考值、非妊娠参考值、美国甲状腺学会（ATA）制定的参考值对妊娠期甲状腺功能异常的总诊出率分别为5．17％、5．45％、6．01％，差异无统计学意义（χ^2=0．498，P〉0．05），但对亚临床甲减的检出率差异有统计学意义（χ^2=9．661，P〈0．05）。结论妊娠期甲状腺各功能指标与健康人群存在显著差异，且在不同妊娠阶段亦存在差异，建立地区特异性的参考值范围能够有效避免甲状腺疾病的误诊或漏诊，减少妊娠不良结局。Objective To establish trimester - specific reference intervals of thyroid hormones for pregnancy in normal iodine intake. Methods A total of 716 pregnant women were selected as research subjects,and another 307 normal women without pregnancy were served as control group. The serum thyroid stimulating hormone （TSH）, free thyroxine（FT4）,free three iodine thyroid gland originalacid（FT3） were measured by chemiluminescent microparticle immunoassay. The changes of thyroid indicators in different gestational period were analyzed, and the thyroid reference range during pregnancy was established. Results The levels of TSH, FT3 and FT4 in non - pregnant women and women in different pregnancy were significantly different （ F = 78. 901,249.571,137. 090, all P 〈 0.05 ）, in which the TSH increased with the increase of ges＇tational age,while the FT3 and FT4 decreased with the increase of gestational age. The reference range of TSH in the early, middle and late gestational weeks were 0. 12 -4.82mIU/L,0.60 - 4. 25mIU/L,0.37 - 4.03mIU/L; the reference range of FT3 in the early, middle and late gestational weeks were 3.81 -6.10pmol/L,3.40- 5.20pmol/L, 3.00 -5.00pmol/L; and the reference range of FT4 in the early, middle and late gestational weeks were 12.85 -22.12pmol/L, 10.81 - 17.66pmol/L, 10.96 - 18.20pmol/L, respectively. The diagnostic rates for thyroid dysfunction of reference values, non - pregnancy reference values and reference values established by American Thyroid Society （ATA） were 5. 17%, 5.45% and 6.01%, respectively, which showed no statistically significant difference among the three groups （χ^2 = 0. 498, P 〉 0.05 ）. However, the difference among the three diagnostic criteria for subclinical hypothyroidism was statistically significant （χ^2 = 9. 661, P 〈 0. 05 ）. Conclusion The thyroid function indicators of pregnant women are significantly different from those of normal people, and there are differences in different stages of pregnancy. Establishing a region - specific referen

关 键 词：妊娠 促甲状腺素 游离甲状腺素 游离三碘甲状腺原氨酸 

分 类 号：R714.256[医药卫生—妇产科学]