摘要
目的建立上海地区妊娠早、中期甲状腺激素正常参考值范围,探究其变化趋势。方法对2014年7月至2015年7月在上海长宁区妇幼保健院门诊检查的1 233例单胎孕妇和364例非妊娠健康妇女进行研究,按照美国临床生化研究院筛选标准选出其中993例孕妇作为建立正常参考值的＂标准人群＂。采用化学发光免疫分析法检测在孕8~12＋6周及孕13~18周血清促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）水平,建立TSH、FT4及FT3妊娠特异性参考值范围,研究其在妊娠期的变化趋势。结果 （1）孕8~12＋6周、孕13~18周和非妊娠期TSH中位数（P2.5,P97.5）分别为：1.48（0.08,4.49）、2.25（0.54,5.20）、1.76（0.56,4.90）mU/L;FT4中位数（P2.5,P97.5）分别为：10.23（8.09,13.81）、9.52（7.86,12.07）、11.22（8.64,15.36）pmol/L;FT3中位数（P2.5,P97.5）分别为：4.28（3.64,5.53）、4.12（3.17,5.16）、4.47（3.79,5.84）pmol/L。（2）TSH在孕8~12＋6周较非妊娠期降低,在孕13~18周较孕8~12＋6周升高。与非妊娠期相比,FT4及FT3水平在孕8~12＋6周及孕13~18周逐步降低。孕8~12＋6周、孕13~18周和非妊娠期各组间血清TSH、FT4及FT3水平差异均有统计学意义（P〈0.05）。（3）孕8~12＋6周时,TSHP97.5者占71%（12/17）,于孕13~18周随访TSH、FT4均在正常范围。结论妊娠期妇女甲状腺功能发生特异性变化,不能采用非妊娠参考值范围。2011年美国甲状腺学会推荐的参考值并不适合于上海地区妊娠妇女。
Objective To analyze the reference value range and changes of thyroid hormone in first and second trimester of pregnancy.Methods A total of 1 233 singleton pregnant women received antenatal care and 364non-pregnant health women were studied and according to the screening criteria of National Academy of Clinical Biochemistry（NACB）,993 pregnant women were selected as the reference.Serum thyroid stimulating hormone（TSH）,free thyroxine（FT4）and free triiodothyronine（FT3）were tested by chemiluminescence immunoassay at 8-12＋6 and 13-18 weeks of gestation.Results The median and reference intervals [M（P2.5-P97.5）]of TSH at 8-12＋6,13-18 weeks of gestation and in non-pregnant women were 1.48（0.08-4.49）,2.25（0.54-5.20）and 1.76（0.56-4.90）mU/L respectively.The median and reference intervals of FT4 were 10.23（8.09-13.81）,9.52（7.86-12.07）and 11.22（8.64-15.36）pmol/L and which of FT3 were 4.28（3.64-5.53）,4.12（3.17-5.16）and 4.47（3.79-5.84）pmol/L respectively.Compared with non-pregnant period,TSH was decreased at 8-12＋6 weeks while increased at 13-18 weeks.Compared with the non-pregnant period,the levels of FT4 and FT3were decreased from 8-12＋6 to 13-18 weeks of gestation.There were significant differences of TSH,FT4 and FT3between 8-12＋6,13-18 weeks of gestation and non-pregnant period（P〈0.05）.In the group of 8-12＋6 weeks of gestation,the rate of women whose TSH lower than P2.5 was 79%（15/19）and the thyroid function of these individuals was normal in the follow-up visit at 13-18 weeks.The rate of women whose TSH higher than P97.5 was 71%（12/17）and thyroid function of these individuals was also normal in the follow-up visit at 13-18 weeks.Conclusion Because of the specific changes of thyroid function in pregnant women,it is not suitable to use the reference intervals of non-pregnant population.The reference values recommended by the American Thyroid Association in 2011 may not be applicable to the pregnant women in the local area.
出处
《国际检验医学杂志》
CAS
2016年第11期1488-1491,共4页
International Journal of Laboratory Medicine
关键词
妊娠
甲状腺功能
参考值
pregnancy
thyroid function
reference values
