摘要
目的探讨建立孕期特异性甲状腺功能正常参考值在评价妊娠晚期甲状腺功能减退中的意义。方法选取2012年7月～12月在上海交通大学附属上海市第六人民医院进行正规产检的1729例单胎妊娠妇女（37周～38周）作为研究对象，检测其甲状腺激素水平。按照美国临床生化研究院（NACB）的推荐方法，选取其中565例健康孕妇建立妊娠晚期甲状腺功能正常参考值范围，并与2011年美国甲状腺学会（ATA）推荐诊断标准比较其在评价妊娠晚期妇女甲状腺功能减退中的作用。结果建立妊娠晚期甲状腺功能正常参考值范围：血清促甲状腺激素（TSH）0．85—6．79mIU／L，血清游离甲状腺激素（FT4）8．45～14．68pmol／L。以此为标准，妊娠期甲状腺功能减退患病率为11．68％（202／1729），其中临床甲状腺功能减退为0．58％（10／1729），亚临床甲状腺功能减退为2．08％（36／1729），低T4血症为9．02％（156／1729）。根据ATA推荐标准，妊娠晚期临床甲状腺功能减退、亚甲状腺功能减退及低T4血症的患病率依次为29．21％（505／1729）、10．41％（180／1729）和40．27％（704／1729），差异有统计学意义（P〈0．05）。血清甲状腺过氧化物酶抗体（TPOAb）阳性妇女69例，甲状腺功能减退患病率0．4％（7／69），其中亚临床甲状腺功能减退占8．70％（6／69），低T4血症占1．45％（1／69），未发现临床甲状腺功能减退患者。TPOAb阴性妇女1660例，甲状腺功能减退患病率11．28％（195／1660），其中临床甲状腺功能减退占0．60％（10／1660），亚临床甲状腺功能减退占1．81％（30／1660），低T4血症占9．34％（155／1660）。TPOAb阳性妇女发生亚临床甲状腺功能减退的比例明显高于TPOAb阴性妇女，差异有统计学意义（x^212．23，P=0．000）；TPOAb阴性妇女中发生低FT4血症的比例明显高于TPOAb阳性妇女，差异有统计学意义（x^2=5，02，P=0．025）。结论甲状腺功能减退在妊娠晚期妇女中仍占相当一部分比重，建立妊娠晚期特异性甲状腺功能参考值可有效提高妊娠期甲状腺功能减退的诊断率，减少不良结局的发生。
Objective To explore the significance of establishment of trimester-specific reference intervals for thyroid function in evaluating hypothyroidism during the third trimester of pregnancy. Methods A total of 1 729 single pregnant women （37-38 gestational weeks ） receiving regular prenatal examination in this hospital from July to December in 2012 were selected as study objects, the levels of thy- roid hormones were detected. According to the method recommended by the National Academy of Clinical Biochemistry （ NACB ） , 565 healthy pregnant women were selected to establish trimester-specific normal reference intervals for thyroid function during the third trimester of pregnancy, the role in evaluating hypothyroidism during the third trimester of pregnancy was compared with the diagnostic criteria recom- mended by ATA in 2011. Results The trimester-specific normal reference intervals for thyroid function during the third trimester of preg- nancy ： serum thyroid-stimulating hormone （TSH） 0. 85-6. 79 mlU/L, serum free thyroid hormone （ FT4 ） 8. 45-14. 68 pmol/L. Based on the criteria, the prevalence rate of hypothyroidism during pregnancy was 11.68% （202/1 729）, the prevalence rates of clinical hypothyroid- ism, subclinical hypothyroidism, and hypothyroxinemia were 0. 58% （10/1 729）, 2.08% （36/1 729）, and 9. 02% （156/1 729）, re- spectively. According to the diagnostic criteria recommended by ATA in 2011, the prevalence rates of clinical hypothyroidism, subclinical hypothyroidism, and hypothyroxinemia during the third trimester of pregnancy were 29. 21% （505/1 729 ）, 10.41% （180/1 729 ）, and 40. 27% （704/1 729 ）, respectively, there was statistically significant difference （P〈0. 05 ） . Sixty-nine pregnant women were found with positive thyroid peroxidase antibody （ TPOAb ） , the prevalence rate of hypothyroidism was 0. 4% （ 7/69 ）, subclinical hypothyroidism ac- counted for 8.70% （6/69） , hypothyroxinemia accounted for 1.45% （1/69） , no pregnant women was found with clinical hypothyroidism. A total of 1 660 pregnant women were found with negative TPOAb, the prevalence rate of hypothyroidism was 11.28% （ 195/1 660） , clini- cal hypothyroidism accounted for 0. 60% （10/1 660） , subclinical hypothyroidism accounted for 1.81% （30/1 660） , hypothyroxinemia ac- counted for 9.34% （ 155/1 660 ） . The proportion of pregnant women with subclinical hypothyroidism among TPOAb positive pregnant women was statistically significantly higher than that among TPOAb negative pregnant women （x^2 = 12. 23, P = O. 000 ） ; the proportion of pregnant women with hypothyroxinemia among TPOAb negative pregnant women was statistically significantly higher than that among TPOAb positive pregnant women （x^2 = 5.02, P = 0. 025 ） . Conclusion Hypothyroidism accounts for a certain proportion of women during the third trimester of pregnancy, establishing trimester-specific reference intervals for thyroid function during the third trimester of pregnancy can effectively improve the diagnostic rate of hypothyroidism durinz oreznancv and reduce adverse reactions.
出处
《中国妇幼保健》
CAS
2015年第29期4964-4967,共4页
Maternal and Child Health Care of China
关键词
妊娠晚期
甲状腺功能减退
参考值
The third trimester of pregnancy
Hypothyroidism
Reference interval
